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Mao H, Shen P. Trial of labor versus elective cesarean delivery for patients with two prior cesarean sections: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2024; 37:2326301. [PMID: 38485519 DOI: 10.1080/14767058.2024.2326301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Cesarean section (CS) rates have been on the rise globally, leading to an increasing number of women facing the decision between a Trial of Labor after two Cesarean Sections (TOLAC-2) or opting for an Elective Repeat Cesarean Section (ERCS). This study evaluates and compares safety outcomes of TOLAC and ERCS in women with a history of two previous CS deliveries. METHODS PubMed, MEDLINE, EMbase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for studies published until 30 June 2023. Eligible studies were included based on predetermined criteria, and a random-effects model was employed to pool data for maternal and neonatal outcomes. RESULTS Thirteen studies with a combined sample size of 101,011 women who had two prior CS were included. TOLAC-2 was associated with significantly higher maternal mortality (odds ratio (OR)=1.50, 95% confidence interval (CI)= 1.25-1.81) and higher chance of uterine rupture (OR = 7.15, 95% CI = 3.44-14.87) compared to ERCS. However, no correlation was found for other maternal outcomes, including blood transfusion, hysterectomy, or post-partum hemorrhage. Furthermore, neonatal outcomes, such as Apgar scores, NICU admissions, and neonatal mortality, were comparable in the TOLAC-2 and ERCS groups. CONCLUSION Our findings suggest an increased risk of uterine rupture and maternal mortality with TOLAC-2, emphasizing the need for personalized risk assessment and shared decision-making by healthcare professionals. Additional studies are needed to refine our understanding of these outcomes in the context of TOLAC-2.
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Affiliation(s)
- Hui Mao
- Delivery Room on the 2nd Floor of the Inpatient Department, Huzhou Maternity & Child Health Care Hospital, Huzhou City, China
| | - Pinghua Shen
- Delivery Room on the 2nd Floor of the Inpatient Department, Huzhou Maternity & Child Health Care Hospital, Huzhou City, China
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Marleen S, Kodithuwakku W, Nandasena R, Mohideen S, Allotey J, Fernández-García S, Gaetano-Gil A, Ruiz-Calvo G, Aquilina J, Khalil A, Bhide P, Zamora J, Thangaratinam S. Maternal and perinatal outcomes in twin pregnancies following assisted reproduction: a systematic review and meta-analysis involving 802 462 pregnancies. Hum Reprod Update 2024; 30:309-322. [PMID: 38345641 PMCID: PMC11063550 DOI: 10.1093/humupd/dmae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/16/2023] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND ART is associated with higher rates of twin pregnancies than singleton pregnancies. Whether twin pregnancies conceived following ART have additional maternal and neonatal complications compared with non-ART twin pregnancies is not known. OBJECTIVE AND RATIONALE The objective was to quantify the risk of adverse maternal and perinatal outcomes among twin pregnancies conceived following ART compared with non-ART and natural conception. Existing reviews vary in the reported outcomes, with many studies including triplet pregnancies in the study population. Therefore, we aimed to perform an up-to-date review with an in-depth analysis of maternal and perinatal outcomes limited to twin pregnancies. SEARCH METHODS We searched electronic databases MEDLINE and EMBASE from January 1990 to May 2023 without language restrictions. All cohort studies reporting maternal and perinatal outcomes following ART compared with non-ART twin pregnancies and natural conception were included. Case-control studies, case reports, case series, animal studies, and in vitro studies were excluded. The Newcastle-Ottawa Scale was used to assess the methodological quality of the studies. Using random-effects meta-analysis, the estimates were pooled and the findings were reported as odds ratios (OR) with 95% CI. OUTCOMES We included 111 studies (802 462 pregnancies). Twin pregnancies conceived following ART were at higher risk of preterm birth at <34 weeks (OR 1.33, 95% CI 1.14-1.56, 29 studies, I2 = 73%), <37 weeks (OR 1.26, 95% CI 1.19-1.33, 70 studies, I2 = 76%), hypertensive disorders in pregnancy (OR 1.29, 95% CI 1.14-1.46, 59 studies, I2 = 87%), gestational diabetes mellitus (OR 1.61, 95% CI 1.48-1.75, 51 studies, I2 = 65%), and caesarean delivery (OR 1.80, 95% CI 1.65-1.97, 70 studies, I2 = 89%) compared with non-ART twins. The risks for the above maternal outcomes were also increased in the ART group compared with natural conception. Of the perinatal outcomes, ART twins were at significantly increased risk of congenital malformations (OR 1.17, 95% CI 1.05-1.30, 39 studies, I2 = 59%), birthweight discordance (>25% (OR 1.31, 95% CI 1.05-1.63, 7 studies, I2 = 0%)), respiratory distress syndrome (OR 1.32, 95% CI 1.09-1.60, 16 studies, I2 = 61%), and neonatal intensive care unit admission (OR 1.24, 95% CI 1.14-1.35, 32 studies, I2 = 87%) compared with non-ART twins. When comparing ART with natural conception, the risk of respiratory distress syndrome, intensive care admissions, and birthweight discordance >25% was higher among the ART group. Perinatal complications, such as stillbirth (OR 0.83, 95% CI 0.70-0.99, 33 studies, I2 = 49%), small for gestational age <10th centile (OR 0.90, 95% CI 0.85-0.95, 26 studies, I2 = 36%), and twin-twin transfusion syndrome (OR 0.45, 95% CI 0.25-0.82, 9 studies, I2 = 25%), were reduced in twin pregnancies conceived with ART versus those without ART. The above perinatal complications were also fewer amongst the ART group than natural conception. WIDER IMPLICATIONS ART twin pregnancies are associated with higher maternal complications than non-ART pregnancies and natural conception, with varied perinatal outcomes. Women seeking ART should be counselled about the increased risks of ART twin pregnancies and should be closely monitored in pregnancy for complications. We recommend exercising caution when interpreting the study findings owing to the study's limitations.
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Affiliation(s)
- Shemoon Marleen
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Obstetrics and Gynaecology, Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - Wasana Kodithuwakku
- Institute of Neurology, National Hospital of Sri Lanka, Colombo 10, Sri Lanka
| | - Ruvini Nandasena
- Department of Obstetrics and Gynaecology, Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - Shezoon Mohideen
- Department of Obstetrics and Gynaecology, Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - John Allotey
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Silvia Fernández-García
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Andrea Gaetano-Gil
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (CIBERESP), Madrid, Spain
| | - Gabriel Ruiz-Calvo
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (CIBERESP), Madrid, Spain
| | | | - Asma Khalil
- St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular and Clinical Sciences Research Institute, St George's Medical School, University of London, London, UK
| | - Priya Bhide
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Javier Zamora
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (CIBERESP), Madrid, Spain
| | - Shakila Thangaratinam
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Centre, Birmingham, UK
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Hu Y, Cui L, Zhang C, Chen F. Timely use of Bakri intrauterine balloon tamponade contributes to the effectiveness in controlling severe postpartum hemorrhage. Exp Ther Med 2024; 27:177. [PMID: 38515648 PMCID: PMC10952343 DOI: 10.3892/etm.2024.12465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
The aim of the present study was to explore the effectiveness of Bakri intrauterine balloon tamponade (IUBT) in treating severe postpartum hemorrhage (SPPH). A cohort of 198 women with SPPH using IUBT were retrospectively selected. The baseline and maternal outcome characteristics were examined. The results demonstrated that women with SPPH had a high proportion of placenta accrete (53.0%). Bakri IUBT demonstrated a global effectiveness of 84.5% in SPPH treatment, accounting for 82.9% in women with placenta accrete. Compared with women with Bakri failure, women who experienced Bakri success had reduced rates of less use of pre-/post-IUBT intervention, blood transfusion, lower genital tract trauma, estimated blood loss (EBL), and a longer indwelling duration (P<0.05). Logistic regression revealed that the pre-IUBT intervention (OR=3.910; 95% CI: 1.684-9.079; P=0.002) was positively associated with hemostasis success, while lower genital tract trauma was negatively associated with Bakri success (OR=0.091; 95% CI: 0.009-0.894; P=0.040). Moreover, women diagnosed with placenta accrete underwent a greater number of transabdominal placed Bakri IUBT and pre-IUBT interventions than those without placenta accrete (P<0.05). No significant differences were observed in Bakri success, total EBL, pre-/post-IUBT EBL, infused volume of IUBT, IUBT indwelling duration, even the rate of hemostasis, lower genital tract trauma, blood transfusion, post-IUBT intervention, and puerperal fever between women with and without placenta accrete (P>0.05). In conclusion, placenta accrete may be the leading cause of SPPH. Bakri IUBT is an effective and safe measure for SPPH. Pre-IUBT intervention may be predictive of Bakri's success. The timely use of IUBT during labor may mitigate the impact of risk factors identified on PPH.
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Affiliation(s)
- Yaping Hu
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430070, P.R. China
| | - Lingjie Cui
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430070, P.R. China
| | - Chong Zhang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430070, P.R. China
| | - Feifei Chen
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430070, P.R. China
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Aprea MG, Schiavetti I, Portaccio E, Ballerini C, Bonavita S, Buscarinu M, Calabrese M, Cavalla P, Cellerino M, Cordioli C, Dattola V, De Biase S, De Meo E, Fantozzi R, Gallo A, Iasevoli L, Karabudak R, Landi D, Lorefice L, Moiola L, Ragonese P, Ruscica F, Sen S, Sinisi L, Signoriello E, Toscano S, Verrengia E, Siva A, Masciulli C, Sormani MP, Amato MP. Impact of COVID-19 on pregnancy and fetal outcomes in women with multiple sclerosis. Mult Scler 2024; 30:707-713. [PMID: 38456445 DOI: 10.1177/13524585241232266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND In the general population, maternal COVID-19 is associated with worse maternal and fetal outcomes. Two previous studies have assessed COVID-19 clinical outcomes in pregnant women with multiple sclerosis (MS), but there are no data about maternal and fetal outcomes. OBJECTIVES In this multicenter study, we aimed to assess maternal and fetal outcomes in pregnant women with MS and COVID-19 infection. METHODS We recruited pregnant patients with MS who contracted COVID-19 and were followed up in Italian and Turkish Centers, during 2020-2022. A control group was extracted from a previous Italian cohort. Associations between group (COVID-19 or healthy patients) and clinical outcomes (maternal complications, fetal malformations, and spontaneous abortion) were investigated with a weighted logistic regression where propensity score-based inverse probability of treatment weighting (IPTW) approach was applied for adjusting for difference in baseline confounders. RESULTS In the multivariable analysis, COVID-19 during pregnancy was associated with a higher risk of maternal complications (odd ratio (OR) = 2.12; 95% confidence interval (CI) = 1.32-3.48; p = 0.002), while it was not associated with higher risk of spontaneous abortion and fetal malformations. CONCLUSION Our data indicate that COVID-19 during pregnancy increases the risk of maternal complications, while it seems to have no significant impact on fetal outcomes.
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Affiliation(s)
| | - Irene Schiavetti
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genova, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Chiara Ballerini
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Simona Bonavita
- II Division, Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Massimiliano Calabrese
- The Multiple Sclerosis Centre, Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Maria Cellerino
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Montichiari Hospital, Brescia, Italy
| | - Vincenzo Dattola
- MS Center, Bianchi Melacrino Morelli Great Metropolitan Hospital, Reggio Calabria, Italy
| | | | - Ermelinda De Meo
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | | | - Antonio Gallo
- MS Center, I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Rana Karabudak
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Lorena Lorefice
- Multiple Sclerosis Centre, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | - Lucia Moiola
- Multiple Sclerosis Center and Neurology Department IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Sedat Sen
- School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | - Elisabetta Signoriello
- II Division, Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Simona Toscano
- Multiple Sclerosis Unit, University Hospital G. Rodolico, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Elena Verrengia
- Multiple Sclerosis Centre, ASST OVEST MI, Legnano Hospital, Legnano, Italy
| | - Aksel Siva
- Faculty of Medicine, Cerrahpasa University, Istanbul, Turkey
| | | | - Maria Pia Sormani
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Vuong ADB, Pham TH, Pham XTT, Truong DP, Nguyen XT, Trinh NB, Nguyen DV, Nguyen YON, Nguyen TNTN, Ho QN, Nguyen PN. Modified one-step conservative uterine surgery (MOSCUS) versus cesarean hysterectomy in the management of placenta accreta spectrum: A single-center retrospective analysis based on 619 Vietnamese pregnant women. Int J Gynaecol Obstet 2024; 165:723-736. [PMID: 38009657 DOI: 10.1002/ijgo.15220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To compare maternal outcome measures in surgical management of placenta accreta spectrum (PAS)-the modified one-step conservative uterine surgery (MOSCUS), a new approach at Tu Du Hospital in Vietnam, versus cesarean hysterectomy, and to identify factors that appear to contribute to the successful outcome of the MOSCUS. METHODS This retrospective study was conducted at Tu Du Hospital in southern Vietnam between January 2019 and December 2020. The study enrolled all pregnant women at more than 28 weeks of pregnancy with a diagnosis of PAS who underwent either a cesarean hysterectomy or a uterus-preserving approach using the MOSCUS method. RESULTS The prevalence of PAS at our single tertiary referral hospital was 0.4% (619 PAS cases/132 518 births) in 2 years. Among 296 patients, the surgical time duration, estimated blood loss, and red blood cell transfusion in the MOSCUS group (n = 217) were all significantly less than in the cesarean hysterectomy group (n = 79) (152.72 ± 42.23 vs 185.13 ± 58.22 min, 1000 vs 1500 mL, and 500 vs 710 mL, respectively). Intraoperatively, the rate of visceral injuries in the hysterectomy group was higher than that in the MOSCUS group (P < 0.001). However, the rate of postoperative infection was higher in the MOSCUS group than in the cesarean hysterectomy group (P = 0.012). Of a total of 217 cases managed using the MOSCUS management, 24 required a secondary hysterectomy; the success rate was 88.9% (95% confidence interval [CI] 84.3%-93.1%). Some of the primary factors associated with the success of MOSCUS included maternal age less than 35 years, planned surgery, severity of PAS, and estimated blood loss during surgery (odds ratio [OR] 5.16, 95% CI 1.96-13.59; OR 3.05, 95% CI 1.08-8.62; OR 3.62, 95% CI 1.19-10.98; and OR 49.66, 95% CI 11.16-221.02, respectively; P < 0.05). CONCLUSION MOSCUS is an acceptable alternative to cesarean hysterectomy in many patients diagnosed with PAS. This new surgical management of PAS resulted in the preservation of the uterus, and a favorable outcome in nearly 9 out of 10 pregnant women. We believe that MOSCUS can be safely offered for the management of PAS in referral hospital settings.
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Affiliation(s)
- Anh Dinh Bao Vuong
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Thanh Hai Pham
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Xuan Trang Thi Pham
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Diem Phuong Truong
- Department of Obstetrics Bloc M, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Xuan Trang Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Ngoc Bich Trinh
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Dinh Vinh Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | | | | | - Quang Nhat Ho
- Department of Postoperative Care Bloc A, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Phuc Nhon Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
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Adebayo T, Adefemi A, Adewumi I, Akinajo O, Akinkunmi B, Awonuga D, Aworinde O, Ayegbusi E, Dedeke I, Fajolu I, Imam Z, Jagun O, Kuku O, Ogundare E, Oluwasola T, Oyeneyin L, Adebanjo-Aina D, Adenuga E, Adeyanju A, Akinsanya O, Campbell I, Kuti B, Olofinbiyi B, Salau Q, Tongo O, Ezekwe B, Lavin T, Oladapo OT, Tukur J, Adesina O. Burden and outcomes of postpartum haemorrhage in Nigerian referral-level hospitals. BJOG 2024. [PMID: 38686455 DOI: 10.1111/1471-0528.17822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/13/2024] [Accepted: 03/24/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria. DESIGN A secondary data analysis using a cross-sectional design. SETTING Referral-level hospitals (48 public and six private facilities). POPULATION Women admitted for birth between 1 September 2019 and 31 August 2020. METHODS Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model. MAIN OUTCOME MEASURES Prevalence of PPH and maternal and neonatal outcomes. RESULTS Of 68 754 women, 2169 (3.2%, 95% CI 3.07%-3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%-2.85%) and 4.0% (95% CI 3.75%-4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8-2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1-3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4-14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5-2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4-4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8-4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions. CONCLUSIONS A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.
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Affiliation(s)
| | | | - Idowu Adewumi
- Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | | | - Bola Akinkunmi
- University of Medical Sciences Teaching Hospital Ondo, Ondo, Nigeria
| | | | | | - Ekundayo Ayegbusi
- Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | | | | | - Zainab Imam
- Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Olusoji Jagun
- Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | | | - Ezra Ogundare
- Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | | | - Lawal Oyeneyin
- University of Medical Sciences Teaching Hospital Ondo, Ondo, Nigeria
| | | | | | | | | | | | - Bankole Kuti
- Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | | | | | | | - Bosede Ezekwe
- Department of Ageing and Life Course, World Health Organization, Nigeria Country Office, Abuja, Nigeria
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Lerner Y, Peled T, Priner Adler S, Rotem R, Sela HY, Grisaru-Granovsky S, Rottenstreich M. Induction of labor in term pregnancies with isolated polyhydramnios: Is it beneficial or harmful? Int J Gynaecol Obstet 2024. [PMID: 38581215 DOI: 10.1002/ijgo.15527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To compare rates of adverse pregnancy outcomes in term pregnancies complicated by polyhydramnios between women who had induction of labor (IOB) versus women who had expectant management. METHODS This multicenter retrospective study included term pregnancies complicated by isolated polyhydramnios. Patients who underwent IOB were compared with those who had expectant management. The primary outcome was defined as a composite adverse maternal outcome, and secondary outcomes were various maternal and neonatal adverse outcomes. Univariate analyses were followed by multivariate logistic regression. RESULTS A total of 865 pregnancies with term isolated polyhydramnios were included: 169 patients underwent IOB (19.5%), while 696 had expectant management and developed spontaneous onset of labor (80.5%). Women who underwent IOB had significantly higher rates of composite adverse maternal outcome (23.1% vs 9.8%, P < 0.01), prolonged hospital stay, perineal tear grade 3/4, intrapartum cesarean, postpartum hemorrhage, blood products transfusion, and neonatal asphyxia compared with expectant management. While the perinatal fetal death rate was similar between the groups (0.6% vs 0.6%, P = 0.98), the timing of the loss was different. Four women in the expectant management group had a stillbirth, while in the induction group one case of intrapartum fetal death occurred due to uterine rupture. Multivariate analyses revealed that IOB was associated with a higher rate of composite adverse maternal outcome (adjusted odds ratio, 2.22 [95% CI, 1.28-3.83]; P < 0.01). CONCLUSION IOB in women with term isolated polyhydramnios is associated with higher rates of adverse maternal outcomes in comparison to expectant management. Further research is needed to determine the optimal approach for the management of isolated polyhydramnios at term.
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Affiliation(s)
- Yael Lerner
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Tzuria Peled
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Shira Priner Adler
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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Piccoli GB, Attini R, Torreggiani M, Chatrenet A, Manzione AM, Masturzo B, Casula V, Longhitano E, Dalmasso E, Biancone L, Pani A, Cabiddu G. Any reduction in maternal kidney mass makes a difference during pregnancy in gestational and fetal outcome. Kidney Int 2024; 105:865-876. [PMID: 38296027 DOI: 10.1016/j.kint.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 11/29/2023] [Accepted: 12/15/2023] [Indexed: 02/19/2024]
Abstract
Little is known about the effect tubulointerstitial nephropathies have in modulating maternal-fetal outcomes in pregnancy. Therefore, we analyzed the main outcomes of pregnancy in these women to gain a better understanding of the role of a reduction in maternal kidney mass. From the Torino Cagliari Observational Study (TOCOS) cohort, we selected 529 patients with a diagnosis of tubulointerstitial disease and focused on 421 patients with chronic kidney disease (CKD) stage 1, without hypertension but with proteinuria less than 0.5 g/day at referral. From a cohort of 2969 singleton deliveries from low-risk pregnancies followed in the same settings we selected a propensity score matched control cohort of 842 pregnancies match 2:1 for age, parity, body mass index, ethnicity, and origin. Time to delivery was significantly shorter in the study cohort 38.0 (Quartile 1-Quartile 3: 37.0-39.0) versus 39.0 (Q1-Q3 38.0-40.0) weeks, with respect to controls. Incidence of delivery of less than 37 gestational weeks significantly increased from controls (7.4%) to women with previous acute pyelonephritis (10.8%), other tubulointerstitial diseases (9.7%) and was the highest in patients with a single kidney (31.1%). Similarly, neonatal birthweight significantly and progressively decreased from controls (3260 g [Q1-Q3: 2980-3530]), previous acute pyelonephritis (3090 g [Q1-Q3: 2868-3405], other tubulointerstitial diseases (3110 g [Q1-Q3: 2840-3417]), and to solitary kidney (2910 g [Q1-Q3: 2480-3240]). Risk of developing preeclampsia was significantly higher in the CKD cohort (3.6% vs 1.7% in low-risk controls). Thus, even a small reduction in functional kidney mass, such as a pyelonephritic scar, is associated with a shorter duration of pregnancy and an increased risk of preterm delivery. The risk is proportional to the extent of parenchymal reduction and is highest in cases with a solitary kidney.
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Affiliation(s)
| | - Rossella Attini
- Department of Obstetrics and Gynecology SC2U, "Città della Salute e della Scienza", Sant'Anna Hospital, Turin, Italy
| | | | - Antoine Chatrenet
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France; APCoSS-Institute of Physical Education and Sports Sciences (IFEPSA), UCO Angers, Angers, France
| | - Ana Maria Manzione
- Division of Nephrology, Dialysis and Renal Transplantation, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Bianca Masturzo
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Viola Casula
- Department of Obstetrics and Gynecology SC2U, "Città della Salute e della Scienza", Sant'Anna Hospital, Turin, Italy
| | - Elisa Longhitano
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France; Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. "G. Martino", University of Messina, Messina, Italy
| | - Eleonora Dalmasso
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France; Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Luigi Biancone
- Division of Nephrology, Dialysis and Renal Transplantation, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Antonello Pani
- Nephrology, Department of Medical Science and Public Health, San Michele Hospital, ARNAS G. Brotzu, University of Cagliari, Cagliari, Italy
| | - Gianfranca Cabiddu
- Nephrology, Department of Medical Science and Public Health, San Michele Hospital, ARNAS G. Brotzu, University of Cagliari, Cagliari, Italy
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Higeta D, Kitahara Y, Tanaka A, Morita A, Sato T, Inoue M, Soda M, Iwase A. Cervical angle as a possible predictor of abnormal placental position in women with endometriosis. J Obstet Gynaecol Res 2024; 50:580-586. [PMID: 38204142 DOI: 10.1111/jog.15885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND We aimed to examine the effects of endometriosis on the rate of abnormal placentation by comparing the data of pregnant women with and without endometriosis. METHODS A case-control study was conducted to compare the perinatal outcomes between women with and without endometriosis. In the subgroup analysis, magnetic resonance imaging (MRI) scans of pregnant women with placenta previa were used to measure the cervical angle and its relationship with endometriosis. The cervical angle was measured as the angle between the cervical glands and the line perpendicular to the spinal column in each sagittal MRI section. RESULTS We retrospectively analyzed data from 3453 cases of singleton deliveries between 2015 and 2019 at two study facilities. Among them, 159 had clinically or surgically confirmed endometriosis. The odds ratio (OR) for abnormal placental position was significantly higher in pregnant women with endometriosis (OR. 2.82; 95% confidence interval [CI], 1.58-5.04). The OR was 3.21 (95% CI, 1.57-6.55) in the endometriosis-surgery group (91 patients) and 2.32 (95% CI, 0.91-5.88) in the non-surgery group (68 patients). Furthermore, 44 women who underwent pelvic MRI after 30 weeks of gestation were included to examine the cervical angle. Then, we compared the date of pregnant women with (n = 6) and without endometriosis (n = 38). Regardless of placental attachment position, the cervical angle was significantly lower in the group with than in the group without a history of endometriosis. CONCLUSION Pregnant women with a history of endometriosis may have stronger uterine retroversion, which could potentially contribute to abnormal placental positioning.
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Affiliation(s)
- Daisuke Higeta
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshikazu Kitahara
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ayuko Tanaka
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihito Morita
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tatsuya Sato
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Maki Inoue
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masayuki Soda
- Department of Obstetrics and Gynecology, Maebashi RedCross Hospital, Maebashi, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Sulaiman SP, Jha N, Bethou A, Nandeeha H, Jha AK. Effect of maternal hyperoxygenation on neonatal outcomes among women in labour with pathological cardiotocography: an open-label randomized controlled trial. Am J Obstet Gynecol 2024; 230:454.e1-454.e11. [PMID: 37778675 DOI: 10.1016/j.ajog.2023.09.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Hyperoxygenation has shown promise in improving suspicious fetal heart patterns in women in labor. However, the effect of hyperoxygenation on neonatal outcomes in women in labor with pathologic fetal heart rate tracing has not been studied. OBJECTIVE This study aimed to evaluate the effect of fractional inspiration of oxygen of 80% compared with fractional inspiration of oxygen of 40% on neonatal outcomes in women with pathologic fetal heart rate tracing. STUDY DESIGN This randomized, open-label, parallel arm, outcome assessor-blinded clinical trial was conducted in a large tertiary care university hospital. Singleton parturients aged ≥18 years at term gestation in active labor (cervical dilatation of ≥6 cm) with pathologic fetal heart rate tracing were recruited in the study. Pathologic fetal heart rate tracing was defined according to the International Federation of Gynecology and Obstetrics 2015 guidelines. The International Federation of Gynecology and Obstetrics classifies fetal heart rate tracings into 3 categories (normal, suspicious, and pathologic) based on rate, variability, and deceleration. Women in the intervention arm received oxygen at 10 L/min via a nonrebreathing mask, and those in the usual care arm received oxygen at 6 L/min with a simple face mask. Oxygen supplementation was continued until cord clamping. The primary outcome measure was a 5-minute Apgar score. The secondary outcome measures were the proportion of neonatal intensive care unit admission, umbilical cord blood gas variables, level of methyl malondialdehyde in the cord blood, and mode of delivery. RESULTS Overall, 148 women (74 women in the high fractional inspiration of oxygen arm and 74 in the low fractional inspiration of oxygen arm) with pathologic fetal heart rate tracing were analyzed. The demographic data, obstetrical profiles, and comorbidities were comparable. The median 5-minute Apgar scores were 9 (interquartile range, 8-10) in the hyperoxygenation arm and 9 (interquartile range, 8-10) in the usual care arm (P=.12). Furthermore, the rate of neonatal intensive care unit admission (9.5% vs 12.2%; P=.6) and the requirement of positive pressure ventilation (6.8% vs 8.1%; P=.75) were comparable. Concerning cord blood gas parameters, the hyperoxygenation arm had a significantly higher base deficit in the umbilical vein and lactate level in the umbilical artery. The cesarean delivery rate was significantly lower in women who received hyperoxygenation (4.1% [3/74]) than in women who received normal oxygen supplementation (25.7% [19/74]) (P=.00). In addition, umbilical vein malondialdehyde level in the umbilical vein was lower in the hyperoxygenation group (8.28±4.65 μmol/L) than in the normal oxygen supplementation group (13.44±8.34 μmol/L) (P=.00). CONCLUSION Hyperoxygenation did not improve the neonatal Apgar score in women with pathologic fetal heart rate tracing. In addition, neonatal intensive care unit admission rate and blood gas parameters remained comparable. Therefore, the results of this trial suggest that a high fractional inspiration of oxygen supplementation confers no benefit on neonatal outcomes in women with pathologic fetal heart rate tracings and normal oxygen saturation.
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Affiliation(s)
- Sruthy P Sulaiman
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nivedita Jha
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Adhisivam Bethou
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Hanumanthappa Nandeeha
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Ehikioya E, Nwachukwu OB, Okobi OE. Effectiveness of Single Fetal Membrane Sweeping in Reducing Elective Labor Induction for Postdate Pregnancies (38+0 to 40+6 Weeks): A Randomized Controlled Trial. Cureus 2024; 16:e58030. [PMID: 38738107 PMCID: PMC11088221 DOI: 10.7759/cureus.58030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Postdate pregnancy is characterized by a heightened risk for both maternal and perinatal complications. Owing to the risks, clinicians frequently turn to elective labor induction as a management strategy for postdate pregnancies. However, patients are increasingly informed and apprehensive about this approach and its associated risks. This has prompted a search for alternative management methods that may encourage spontaneous labor in pregnant women. One such approach is the use of fetal membrane sweeping, a method known to increase the likelihood of spontaneous labor onset. Yet, it remains unclear whether a single fetal membrane sweeping procedure can effectively reduce the need for elective labor induction in postdate pregnancies while minimizing risks to both the mother and fetus. OBJECTIVES The primary objective of this study was to assess the efficacy of a single fetal membrane sweeping procedure conducted between 38+0 and 40+6 weeks of gestation in reducing the rate of elective labor induction among postdate pregnancies at Central Hospital Benin City, Nigeria. Secondary objectives included evaluating the impact of membrane sweeping on maternal and perinatal outcomes. METHODOLOGY This open-label superiority randomized controlled study was carried out from June 2020 to March 2021, following ethical approval from the Hospital Management Board (HMB). One hundred and forty eligible participants, without contraindications to vaginal delivery, were randomly assigned to one of two groups. The first group received a single fetal membrane sweeping procedure between 38+0 and 40+6 weeks of gestation, while the control group underwent vaginal examination only to assess the Bishop score. Participants were monitored until delivery. Data analysis was performed. Results were considered statistically significant at p < 0.05. RESULTS The implementation of a single fetal membrane sweeping procedure effectively reduced the incidence of elective labor induction. Specifically, the membrane sweep group exhibited a significantly lower rate of elective labor induction compared to the control group (9.0% vs. 27.1%; p=0.0083). Moreover, a substantial proportion of the treatment group (91.4%) experienced spontaneous labor, while the control group reported a rate of 72.9%. The difference was statistically significant (p=0.0054). Notably, the control group exhibited a significantly longer mean time interval from recruitment to delivery (10.67±3.51 days) than the membrane sweeping group (3.64±4.123 days; p<0.05). Also, postdate women in the membrane sweep group were less likely to require cervical ripening with Foley's catheter than those in the control group (33.3% vs. 100%; RR: 0.33 (0.11-1.03); p=0.0057). Still, maternal satisfaction was significantly higher in the membrane-sweeping group (p<0.01). No significant differences were noted across the groups in maternal and neonatal outcomes. CONCLUSION In low-risk term pregnancies, a single fetal membrane sweeping procedure is a superior alternative to no membrane sweeping in reducing the rate of elective labor induction for postdate pregnancies and in shortening the duration of term pregnancy.
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Affiliation(s)
| | - Onyinyechukwu B Nwachukwu
- Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Family Medicine, American International School of Medicine, Georgetown, GUY
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, Maryland, USA
- Family Medicine, Lakeside Medical center, Belle Glade, USA
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Subbaraman MS, Schulte A, Berglas NF, Kerr WC, Thomas S, Treffers R, Liu G, Roberts SCM. Associations between alcohol taxes and varied health outcomes among women of reproductive age and infants. Alcohol Alcohol 2024; 59:agae015. [PMID: 38497162 PMCID: PMC10945295 DOI: 10.1093/alcalc/agae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE No studies have examined whether alcohol taxes may be relevant for reducing harms related to pregnant people's drinking. METHOD We examined how beverage-specific ad valorem, volume-based, and sales taxes are associated with outcomes across three data sets. Drinking outcomes came from women of reproductive age in the 1990-2020 US National Alcohol Surveys (N = 11 659 women $\le$ 44 years); treatment admissions data came from the 1992-2019 Treatment Episode Data Set: Admissions (N = 1331 state-years; 582 436 pregnant women admitted to treatment); and infant and maternal outcomes came from the 2005-19 Merative Marketscan® database (1 432 979 birthing person-infant dyads). Adjusted analyses for all data sets included year fixed effects, state-year unemployment and poverty, and accounted for clustering by state. RESULTS Models yield no robust significant associations between taxes and drinking. Increased spirits ad valorem taxes were robustly associated with lower rates of treatment admissions [adjusted IRR = 0.95, 95% CI: 0.91, 0.99]. Increased wine and spirits volume-based taxes were both robustly associated with lower odds of infant morbidities [wine aOR = 0.98, 95% CI: 0.96, 0.99; spirits aOR = 0.99, 95% CI: 0.98, 1.00] and lower odds of severe maternal morbidities [wine aOR = 0.91, 95% CI: 0.86, 0.97; spirits aOR = 0.95, 95% CI: 0.92, 0.97]. Having an off-premise spirits sales tax was also robustly related to lower odds of severe maternal morbidities [aOR = 0.78, 95% CI: 0.64, 0.96]. CONCLUSIONS Results show protective associations between increased wine and spirits volume-based and sales taxes with infant and maternal morbidities. Policies that index tax rates to inflation might yield more public health benefits, including for pregnant people and infants.
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Affiliation(s)
- Meenakshi S Subbaraman
- Behavioral Health and Recovery Studies, Public Health Institute, 555 12th St, Oakland, CA 94607, United States
| | - Alex Schulte
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, S1330 Broadway, Suite 1100, Oakland, CA 94612, United States
| | - Nancy F Berglas
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, S1330 Broadway, Suite 1100, Oakland, CA 94612, United States
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - Sue Thomas
- National Capital Region Center, Pacific Institute of Research and Evaluation, 4061 Powder Mill Road Suite 350, Beltsville, MD 20705-3113, United States
| | - Ryan Treffers
- National Capital Region Center, Pacific Institute of Research and Evaluation, 4061 Powder Mill Road Suite 350, Beltsville, MD 20705-3113, United States
| | - Guodong Liu
- Center for Applied Studies in Health Economics, Pennsylvania State College of Medicine, 90 Hope Drive, Suite 2200, Hershey, PA 17033, United States
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, S1330 Broadway, Suite 1100, Oakland, CA 94612, United States
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Abdelmola A, Albasheer O, Kariri AA, Akkam FM, Hakami RA, Essa SA, Jali FM. Characteristics and Outcomes of Coronavirus Disease- 2019 Among Pregnant Women in Saudi Arabia; a Retrospective Study. Int J Womens Health 2024; 16:475-490. [PMID: 38501054 PMCID: PMC10946403 DOI: 10.2147/ijwh.s445950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/25/2024] [Indexed: 03/20/2024] Open
Abstract
Background Pregnancy-related coronavirus disease 2019 infection ranges from asymptomatic to very serious illness. This study aimed to determine the impact of the COVID-19 infection on pregnant women in the Jazan region of Saudi Arabia. Methods Retrospective observational study of women who had COVID-19 positive test in pregnancy admitted in King Fahd Hospital, Abu Arish General Hospital, and Sabya General Hospital, Jazan, Saudi Arabia during the period between March 2020 and March 2022. Data were extracted from the patient's records. Frequency and percentage distributions were calculated for categorical variables. Descriptive studies and regression analysis were conducted to evaluate the association between selected variables and pregnancy outcomes. Results Of the 33 pregnant women with confirmed infection, the majority were in their second and third trimester, with approximately 42.4% requiring intensive care unit (ICU) admission and oxygen therapy. The most prevalent symptoms were high respiratory rate and low blood pressure, often accompanied by fever, cough, and shortness of breath. Live births resulted in 54.5% of the cases, while two maternal deaths were reported. Significant associations were found between the need for non-invasive ventilation and timing of infection (p = 0.026), the mode of delivery and timing of infection (p = 0.036), and the mode of delivery and body mass index (BMI) (p = 0.007). Conclusion COVID-19 poses significant risks to pregnant women, particularly in the third trimester, and emphasized the importance of early identification of high-risk pregnancies, strategic planning, and enhanced monitoring during antenatal care.
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Affiliation(s)
- Amani Abdelmola
- Department of Family and Community Medicine, Jazan University, Jazan, Saudi Arabia
| | - Osama Albasheer
- Department of Family and Community Medicine, Jazan University, Jazan, Saudi Arabia
| | - Atyaf A Kariri
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Shahd A Essa
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Fawziah M Jali
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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Alsuraykh LA, Alnadawi AA, Alharbi A, Alhumaidi KA, Alhabardi N, Almarshud R. Women's Perceptions and Knowledge Toward Episiotomy in Qassim Region, Saudi Arabia. Cureus 2024; 16:e55383. [PMID: 38562338 PMCID: PMC10984130 DOI: 10.7759/cureus.55383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Episiotomy, despite being one of the most common interventions during childbirth, carries significant risks and uncertain benefits. Previous global studies highlight varying awareness levels and practices, with decreasing episiotomy rates attributed to increased knowledge. This study aims to assess women's knowledge to enhance intrapartum decision-making and communication between patients and obstetricians, ultimately improving maternal outcomes in the region. METHODOLOGY The study was a cross-section design. It was conducted through an online survey that was distributed by different social media platforms (Twitter, WhatsApp, and Telegram) from February 2023 to January 2024. It included women living in the Qassim region, Saudi Arabia, who were 15 years old or older. Data was analyzed using the SPSS program (IBM, Chicago, Illinois, USA). RESULTS Among the 402 participants, 62.7% demonstrated awareness of episiotomy, with 94.0% accurately identifying it as a surgical cutting with scissors. About 82.5% acknowledged that not all women require episiotomies, while 48.8% recognized the necessity of anesthesia before the procedure. Understanding the indications for episiotomy varied, with facilitating and accelerating childbirth (64.3%) and dealing with a large baby (62.3%) being the most recognized reasons. Impressively, 90.5% believed that there are methods to avoid perineal cutting, with knowing the correct mechanism for pushing during childbirth (69.4%) and exercise (54.4%) being the most acknowledged preventive measures. Regarding post-cutting care, antibiotics (61.5%) were identified as essential, followed by analgesia (52.8%) and laxatives (48.8%). CONCLUSION The study reveals a notable awareness among participants, with a majority demonstrating a solid understanding of the procedure, its indications, and post-procedure care. It identified specific knowledge gaps, such as the need for anesthesia awareness and divergent beliefs about post-episiotomy care practices.
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Affiliation(s)
- Lubna A Alsuraykh
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Aseel A Alnadawi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Aeshah Alharbi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Kadi A Alhumaidi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Nadiyah Alhabardi
- Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Raghad Almarshud
- General Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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Lopez A, Wen T, Patel N, Booker WA, D'Alton ME, Friedman AM. Trends in and outcomes of delivery hospitalizations with lupus and antiphospholipid syndrome. Int J Gynaecol Obstet 2024; 164:1001-1009. [PMID: 37789684 DOI: 10.1002/ijgo.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To assess trends and outcomes associated with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) during US delivery hospitalizations. STUDY DESIGN The National Inpatient Sample from 2000 to 2019 was used for this repeated cross-sectional analysis. We identified delivery hospitalizations with and without SLE. Temporal trends in SLE during delivery hospitalizations were determined using joinpoint regression. Adjusted logistic regression models accounting for demographic, clinical, and hospital factors were used to determine adjusted odds ratios (aORs) for adverse outcomes based on the presence or absence of SLE. RESULTS Of an estimated 76 698 775 delivery hospitalizations identified in the NIS, 79386 (0.10%) had an associated diagnosis of SLE. Over the study period, SLE increased from 6.7 to 14.6 cases per 10 000 delivery hospitalizations (average annual percent change 4.5%, 95% CI 4.0-5.1). Deliveries with SLE had greater odds of non-transfusion severe morbidity (aOR 2.21, 95% CI 2.00, 2.44) and underwent a larger absolute increase in morbidity risk over the study period. SLE was associated with a range of other adverse outcomes including preterm delivery, eclampsia, cesarean delivery, and blood transfusion. CONCLUSION The proportion of deliveries to women with SLE has increased over time in the US, and SLE and APS are associated with a broad range of adverse outcomes.
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Affiliation(s)
- Ashley Lopez
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Timothy Wen
- Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, California, USA
| | - Naomi Patel
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
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Rajavel S, Sathiabalan M, Singh T. Maternal and neonatal outcomes during COVID-19 pandemic and pre-pandemic in an urban slum in North India - A community-based ambispective cohort study. J Family Med Prim Care 2024; 13:977-983. [PMID: 38736777 PMCID: PMC11086783 DOI: 10.4103/jfmpc.jfmpc_1309_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 05/14/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has affected millions of people globally since its first case reported on December 2019 in Wuhan, China. The maternal and neonatal outcomes during COVID-19 pandemic were not much reported in low- and middle-income countries. Therefore, we aimed to assess the maternal and neonatal outcomes during COVID-19 and compared them with those of the pre-pandemic period (i.e., 2019). Materials and Methods We obtained data from the cohort of pregnant women who delivered during COVID-19 pandemic and women who delivered in the pre-pandemic period. All registered antenatal mothers resident of the selected dispensary who delivered in health care facilities from January 2019 to June 2019 and from January 2021 to June 2021 were included in the study for assessing the socio-demographic, antenatal, natal, post-natal, and new-born characteristics. A semi-structed questionnaire was used for obtaining details regarding pregnancy and COVID-19 status. The neuro-development assessment of the newborn was done in the community using Trivandrum Developmental Screening Chart (TDSC). Chi-square test and Fischer exact test were used to draw association between the maternal and neonatal outcomes during COVID-19 pandemic and the pre-COVID-19 period. A P value of <0.05 was considered statistically significant. Results A total of 158 and 220 women delivered in pre-COVID and during COVID, respectively. Out of them, 83 mothers (47.4%) who delivered in 2019 (pre-COVID) and 158 mothers (76.4%) who delivered in 2021 (during pandemic) were contacted. The mean age was 25 ± 3.9 years. The prevalence of anemia was significantly higher during COVID pandemic. The proportion of Rh-negative mothers and other antenatal investigation reports was similar in both the groups. The proportion of high-risk pregnancy is high among mothers who delivered during COVID than the pre-COVID period. On applying multivariate analysis, developmental delay at 3 months was found to be significant among children who were born during pandemic. Conclusion A simple tool was used for assessing development milestones, and we have found that newborns delivered during COVID-19 pandemic were reported to have inappropriate developmental milestone at 3 months post-delivery. However, further research needed to assess the neuro-developmental status and follow-up of children born during COVID-19 pandemic for comprehensive neuro-developmental assessment. It is important to identify children with developmental delays associated with the pandemic and provide them with support for learning, socialization, physical and mental health, and family support.
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Affiliation(s)
- Saranya Rajavel
- Department of Community Medicine, ESIC Medical College and PGIMSR, Rajaji Nagar, Bengaluru, Karnataka, India
| | - M Sathiabalan
- Department of Community Medicine, ESIC Medical College and PGIMSR, Rajaji Nagar, Bengaluru, Karnataka, India
| | - Tarundeep Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Libretti A, Troìa L, Cappello AM, Casarotti C, D'Amato AT, Dallarda G, Ghio M, Nicosia A, Ricci D, Savasta F, Sonzini M, Villa D, De Pedrini A, Surico D, Remorgida V. Pregnancy and neonatal outcomes of SARS-CoV-2 infection discovered at the time of delivery: a tertiary center experience in North Italy. J Perinat Med 2024; 52:215-221. [PMID: 37846639 DOI: 10.1515/jpm-2023-0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Although the knowledge on SARS-CoV-2 infection in pregnancy has greatly improved, there is still a lack of information on its role in the later stages of gestation. The aim of this study is to investigate whether SARS-CoV-2 discovered at delivery is associated with any obstetric or neonatal complications. METHODS A retrospective case-control study was conducted at Department of Obstetrics, University Hospital Maggiore della Carità, Novara, Italy, from March 2020 to March 2023. Pregnant women admitted were tested for SARS-CoV-2. 168 women resulted positive at the time of delivery; the women were asymptomatic or paucisymptomatic. 170 negative women were selected as controls, selecting, for each SARS-CoV-2 positive patient, the patient who gave birth right before, if negative. Demographic and anamnestic characteristics, pregnancy, labor, and neonatal outcomes were evaluated. RESULTS SARS-CoV-2 positive patients were more likely to have gestational diabetes (13.7 vs. 5.3 %) and required less frequently intrapartum analgesia (11.3 vs. 27 %) and labor augmentation (7.3 vs. 16.5 %). Post-partum hemorrhage rate was lower (13.7 vs. 22.9 %) and a shorter length of first and second stage of labor occurred. There were no statistically significant differences between the two groups regarding the mode of delivery and neonatal outcomes. CONCLUSIONS SARS-CoV-2 positive patients have shorter labor length and a lower incidence of postpartum hemorrhage. Fewer obstetric interventions, as well as less use of intrapartum analgesia and oxytocin, could explain these findings. Moreover, gestational diabetes could increase susceptibility to infection. SARS-CoV-2 infection discovered at the time of delivery in asymptomatic or paucisymptomatic patients does not appear to increase the rate of cesarean delivery or other obstetric complications, and neonatal outcomes have not worsened.
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Affiliation(s)
- Alessandro Libretti
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Libera Troìa
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Anna Maria Cappello
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Carolina Casarotti
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Alessia Tony D'Amato
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Gloria Dallarda
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Matilda Ghio
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Anthony Nicosia
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Daria Ricci
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Federica Savasta
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Michela Sonzini
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Diletta Villa
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Alberto De Pedrini
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Daniela Surico
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Valentino Remorgida
- Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
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18
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Wen T, Logue TC, Wright JD, D'Alton M, Booker WA, Friedman AM. Adverse delivery hospitalisation outcomes in 2020 during the COVID-19 pandemic. BJOG 2024. [PMID: 38375533 DOI: 10.1111/1471-0528.17783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To evaluate risk for adverse obstetric outcomes associated with the coronavirus disease 2019 (COVID-19) pandemic period and with COVID-19 diagnoses. DESIGN Serial cross-sectional study. SETTING A national sample of US delivery hospitalisations before (1/2016 to 2/2020) and during the first 10 months of (3/2020 to 12/2020) the COVID-19 pandemic. POPULATION All 2016-2020 US delivery hospitalisations in the National Inpatient Sample. METHODS Delivery hospitalisations were identified and stratified into pre-pandemic and pandemic periods and the likelihood of adverse obstetric outcomes was compared using logistic regression models with adjusted odds ratios (aOR) with 95% confidence intervals (CI) as measures of association. Risk for adverse outcomes was also analysed specifically for 2020 deliveries with a COVID-19 diagnosis. MAIN OUTCOME MEASURE Adverse maternal outcomes including respiratory complications and cardiac morbidity. RESULTS Of an estimated 18.2 million deliveries, 2.9 million occurred during the pandemic. The proportion of delivery hospitalisations with a COVID-19 diagnosis increased from 0.1% in March 2020 to 3.1% in December. Comparing the pandemic period to the pre-pandemic period, there were higher adjusted odds of transfusion (aOR 1.12, 95% CI 1.05-1.19), a respiratory complication composite (aOR 1.37, 95% CI 1.29-1.46), cardiac severe maternal morbidity (aOR 1.30, 95% 1.20-1.39), postpartum haemorrhage (aOR 1.19, 95% CI 1.15-1.24), placental abruption/antepartum haemorrhage (OR 1.04, 95% CI 1.00-1.08), and hypertensive disorders of pregnancy (OR 1.23, 95% CI 1.21-1.26). These associations were similar to unadjusted analysis. Risk for these outcomes during the pandemic period was significantly higher in the presence of a COVID-19 diagnosis. CONCLUSIONS In a national estimate of delivery hospitalisations, the odds of cardiac and respiratory outcomes were higher in 2020 compared with 2016-2019. COVID-19 diagnoses were specifically associated with a range of serious complications.
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Affiliation(s)
- Timothy Wen
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware, USA
| | - Jason D Wright
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California, USA
| | - Mary D'Alton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California, USA
| | - Whitney A Booker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California, USA
| | - Alexander M Friedman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California, USA
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Soman DA, Joseph A, Moore A. Influence of the Physical Environment on Maternal Care for Culturally Diverse Women: A Narrative Review. HERD 2024:19375867241227601. [PMID: 38379226 DOI: 10.1177/19375867241227601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES This narrative literature review aims to develop a framework that can be used to understand, study, and design maternal care environments that support the needs of women from diverse racial and ethnic groups. BACKGROUND Childbirth and the beginning of life hold particular significance across many cultures. People's cultural orientation and experiences influence their preferences within healthcare settings. Research suggests that culturally sensitive care can help improve the experiences and outcomes and reduce maternal health disparities for women from diverse cultures. At the same time, the physical environment of the birth setting influences the birthing experience and maternal outcomes such as the progression of labor, the use of interventions, and the type of birth. METHODS The review synthesizes articles from three categories: (a) physical environment of birthing facilities, (b) physical environment and culturally sensitive care, and (c) physical environment and culturally sensitive birthing facilities. RESULTS Fifty-five articles were identified as relevant to this review. The critical environmental design features identified in these articles were categorized into different spatial scales: community, facility, and room levels. CONCLUSIONS Most studies focus on maternal or culturally sensitive care settings outside the United States. Since the maternal care environment is an important aspect of their culturally sensitive care experience, further studies exploring the needs and perspectives of racially and ethnically diverse women within maternal care settings in the United States are necessary. Such research can help future healthcare designers contribute toward addressing the ongoing maternal health crisis within the country.
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Affiliation(s)
- Devi A Soman
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, SC, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, Clemson University, SC, USA
- School of Architecture and Industrial Engineering, Clemson University, SC, USA
| | - Arelis Moore
- Community Health and Spanish, Department of Languages, Clemson University, SC, USA
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Vogel JP, Nguyen PY, Ramson J, De Silva MS, Pham MD, Sultana S, McDonald S, Adu-Bonsaffoh K, McDougall ARA. Effectiveness of care bundles for prevention and treatment of postpartum hemorrhage: a systematic review. Am J Obstet Gynecol 2024:S0002-9378(24)00042-5. [PMID: 38336124 DOI: 10.1016/j.ajog.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Care bundles are a promising approach to reducing postpartum hemorrhage-related morbidity and mortality. We assessed the effectiveness and safety of care bundles for postpartum hemorrhage prevention and/or treatment. DATA SOURCES We searched MEDLINE, Embase, Cochrane CENTRAL, Maternity and Infant Care Database, and Global Index Medicus (inception to June 9, 2023) and ClinicalTrials.gov and the International Clinical Trials Registry Platform (last 5 years) using a phased search strategy, combining terms for postpartum hemorrhage and care bundles. STUDY ELIGIBILITY CRITERIA Peer-reviewed studies evaluating postpartum hemorrhage-related care bundles were included. Care bundles were defined as interventions comprising ≥3 components implemented collectively, concurrently, or in rapid succession. Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies (controlled or uncontrolled) were eligible. METHODS Risk of bias was assessed using RoB 2 (randomized trials) and ROBINS-I (nonrandomized studies). For controlled studies, we reported risk ratios for dichotomous outcomes and mean differences for continuous outcomes, with certainty of evidence determined using GRADE. For uncontrolled studies, we used effect direction tables and summarized results narratively. RESULTS Twenty-two studies were included for analysis. For prevention-only bundles (2 studies), low-certainty evidence suggests possible benefits in reducing blood loss, duration of hospitalization, and intensive care unit stay, and maternal well-being. For treatment-only bundles (9 studies), high-certainty evidence shows that the E-MOTIVE intervention reduced risks of composite severe morbidity (risk ratio, 0.40; 95% confidence interval, 0.32-0.50) and blood transfusion for bleeding, postpartum hemorrhage, severe postpartum hemorrhage, and mean blood loss. One nonrandomized trial and 7 uncontrolled studies suggest that other postpartum hemorrhage treatment bundles might reduce blood loss and severe postpartum hemorrhage, but this is uncertain. For combined prevention/treatment bundles (11 studies), low-certainty evidence shows that the California Maternal Quality Care Collaborative care bundle may reduce severe maternal morbidity (risk ratio, 0.64; 95% confidence interval, 0.57-0.72). Ten uncontrolled studies variably showed possible benefits, no effects, or harms for other bundle types. Nearly all uncontrolled studies did not use suitable statistical methods for single-group pretest-posttest comparisons and should thus be interpreted with caution. CONCLUSION The E-MOTIVE intervention improves postpartum hemorrhage-related outcomes among women delivering vaginally, and the California Maternal Quality Care Collaborative bundle may reduce severe maternal morbidity. Other bundle designs warrant further effectiveness research before implementation is contemplated.
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Affiliation(s)
- Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Phi-Yen Nguyen
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jen Ramson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Manarangi S De Silva
- Department of Obstetrics, Gynaecology and Newborn Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Minh D Pham
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Saima Sultana
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Steve McDonald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Annie R A McDougall
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
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21
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Pandit C, Paneru R, Chapagain S, Lama CS, Khadka B, Shrestha S, Basnet A, Subedi K, Koirala RR, Maharjan S, Karn M. Assessment of severity and feto- maternal outcomes among COVID-19 infected pregnant females hospitalized at tertiary care center in western Nepal. Ann Med Surg (Lond) 2024; 86:789-792. [PMID: 38333291 PMCID: PMC10849309 DOI: 10.1097/ms9.0000000000001684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/24/2023] [Indexed: 02/10/2024] Open
Abstract
Objective There is a paucity of data assessing the severity of coronavirus disease 2019 (COVID-19) infection and feto-maternal outcomes in pregnant women in Nepal, especially during the third wave of the pandemic with the Delta variant. This study aimed to severity as well as maternal-fetal outcomes among pregnant women with COVID-19 infection. Methods In this cross-sectional study carried out amongst COVID-19 positive pregnant women visiting our institution for 6 months from January through June 2022, data surrounding COVID-19 severity and fetal outcomes were collected in a structured questionnaire. Disease severity was categorized based on the NIH (National Institutes of Health) severity classification. Descriptive statistics were used to describe the outcomes. Results A total of 105 pregnant females infected with COVID-19 during the third wave were included in our study. The participants ranged from 16 through 40 years, mean gestational age being 36.6 weeks. Most of the women (40.55%) belonged to Brahmin and Chhetri ethnic backgrounds. About half (48.55%) of females were asymptomatic and four patients had severe disease requiring intensive care management. Only 13 pregnant females underwent vaccination. Of the 91 females that underwent delivery at our center, 77 (84.62%) were term. The rate of cesarean delivery was slightly higher (51.65%) than normal delivery. None of the babies born to COVID-positive pregnant females tested positive for COVID-19 and there were no stillbirths or any congenital anomalies. The majority of babies (68.14%) had normal fetal weight. Conclusion Severe COVID-19 infection and adverse maternal-fetal outcomes during the third wave of COVID-19 infection with the Delta variant in Nepal were less than in other regions of the world despite low rates of vaccination.
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Affiliation(s)
- Chandika Pandit
- Department of Obstetrics and Gynecology, Gandaki Medical College Teaching Hospital, and Research Center, Pokhara, Nepal
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Sonbol B, Orabi A, Al Najjar H. Impact of the Timing of Umbilical Cord Clamping on Maternal and Neonatal Outcomes in Saudi Arabia. Cureus 2024; 16:e53536. [PMID: 38445130 PMCID: PMC10912892 DOI: 10.7759/cureus.53536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION The optimal time for umbilical cord clamping after delivery has been under debate for several decades. This study aimed to assess the time-dependent effects of umbilical cord clamping on maternal and neonatal outcomes. METHODS An observational correlational design was used to recruit 161 pregnant women conveniently. Outcomes were observed and recorded using a structured checklist developed by the authors. Pregnant females aged ≥18 years, with uncomplicated delivery, and who were willing to participate were recruited. Exclusion criteria included stillbirths, newborns with congenital anomalies, newborns too small for their gestational age, intra-uterine growth restriction, nuchal cord, and meconium-stained liquor. RESULTS The mean age of the participants was 29.93 ± 6 years. Early clamping (<1 minute) was performed for 93.8% of the participants with a mean of 29.58 ± 18 seconds. Delayed clamping was associated with a decrease in blood loss and the length of hospital stay in addition to an increase in first-minute APGAR score and neonatal temperature (P < 0.05). CONCLUSIONS Delayed cord clamping was associated with improved maternal and neonatal outcomes.
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Affiliation(s)
- Bayan Sonbol
- Obstetrics and Gynecology, King Salman bin Abdulaziz Medical City, Madinah, SAU
| | - Abeer Orabi
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Nursing, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hend Al Najjar
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Nursing, King Abdullah International Medical Research Center, Jeddah, SAU
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Xu J, Wang H, Bian J, Xu M, Jiang N, Luo W, Zu P, Yin W, Zhu P. Association between the Maternal Mediterranean Diet and Perinatal Outcomes: A Systematic Review and Meta-Analysis. Adv Nutr 2024; 15:100159. [PMID: 38042258 PMCID: PMC10801312 DOI: 10.1016/j.advnut.2023.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023] Open
Abstract
The Mediterranean diet is a global, well-known healthy dietary pattern. This review aims to synthesize the existing evidence on the relationship between the maternal Mediterranean diet during pregnancy and perinatal outcomes, including randomized controlled trials (RCTs) and cohort studies. PubMed, Web of Science, and the Cochrane Library were searched from inception to 10 March, 2023, supplemented by manual screening. A random-effect model was used to estimate pooled sizes with 95% confidence intervals (CIs) for specific outcomes of interest. Data from 5 RCTs and 18 cohort studies with 107,355 pregnant participants were synthesized. In RCTs, it was observed that the maternal Mediterranean diet significantly reduced the incidence of gestational diabetes mellitus [odds ratio (OR), 0.56; 95% CI: 0.34, 0.93], as well as small for gestational age (0.55; 95% CI: 0.35, 0.88). In cohort studies, the highest adherence score to the maternal Mediterranean diet was inversely associated with a lower risk of various adverse pregnancy outcomes, including gestational diabetes mellitus (OR, 0.82; 95% CI: 0.67, 1.00), pregnancy-induced hypertension (0.73; 95% CI: 0.60, 0.89), pre-eclampsia (0.77; 95% CI: 0.64, 0.93), preterm delivery (0.67; 95% CI: 0.49, 0.91), low birth weight (0.70; 95% CI: 0.64, 0.78), intrauterine growth restriction (0.46; 95% CI: 0.23, 0.91), and increased gestational age at delivery (weighted mean difference, 0.11 wk; 95% CI: 0.03, 0.20). Meta-regression analyses did not identify the adjustment for confounders and geographical location as predictive factors for heterogeneity. The results suggest that adherence to the Mediterranean diet during pregnancy appears to be beneficial for perinatal outcomes. Future, larger, and higher-quality RCTs and cohort studies are warranted to confirm the present findings. PROSPERO registration no.: CRD42023406317.
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Affiliation(s)
- Jirong Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China; Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China
| | - Haixia Wang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Jingfeng Bian
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Ming Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Nan Jiang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Wei Luo
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Ping Zu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Wanjun Yin
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China; Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China.
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Greco E, Calanducci M, Nicolaides KH, Barry EVH, Huda MSB, Iliodromiti S. Gestational diabetes mellitus and adverse maternal and perinatal outcomes in twin and singleton pregnancies: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:213-225. [PMID: 37595821 DOI: 10.1016/j.ajog.2023.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE This study aimed to assess the risk of adverse maternal and perinatal complications between twin and singleton pregnancies affected by gestational diabetes mellitus and the respective group without gestational diabetes mellitus (controls). DATA SOURCES A literature search was performed using MEDLINE, Embase, and Cochrane from January 1980 to May 2023. STUDY ELIGIBILITY CRITERIA Observational studies reporting maternal and perinatal outcomes in singleton and/or twin pregnancies with gestational diabetes mellitus vs controls were included. METHODS This was a systematic review and meta-analysis. Pooled estimate risk ratios with 95% confidence intervals were generated to determine the likelihood of adverse pregnancy outcomes between twin and singleton pregnancies with and without gestational diabetes mellitus. Heterogeneity among studies was evaluated in the model and expressed using the I2 statistic. A P value of <.05 was considered statistically significant. The meta-analyses were performed using Review Manager (RevMan Web). Version 5.4. The Cochrane Collaboration, 2020. Meta-regression was used to compare relative risks between singleton and twin pregnancies. The addition of multiple covariates into the models was used to address the lack of adjustments. RESULTS Overall, 85 studies in singleton pregnancies and 27 in twin pregnancies were included. In singleton pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (relative risk, 1.85; 95% confidence interval, 1.69-2.01), induction of labor (relative risk, 1.36; 95% confidence interval, 1.05-1.77), cesarean delivery (relative risk, 1.31; 95% confidence interval, 1.24-1.38), large-for-gestational-age neonate (relative risk, 1.61; 95% confidence interval, 1.46-1.77), preterm birth (relative risk, 1.36; 95% confidence interval, 1.27-1.46), and admission to the neonatal intensive care unit (relative risk, 1.43; 95% confidence interval, 1.38-1.49). In twin pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (relative risk, 1.69; 95% confidence interval, 1.51-1.90), cesarean delivery (relative risk, 1.10; 95% confidence interval, 1.06-1.13), large-for-gestational-age neonate (relative risk, 1.29; 95% confidence interval, 1.03-1.60), preterm birth (relative risk, 1.19; 95% confidence interval, 1.07-1.32), and admission to the neonatal intensive care unit (relative risk, 1.20; 95% confidence interval, 1.09-1.32) and reduced risks of small-for-gestational-age neonate (relative risk, 0.89; 95% confidence interval, 0.81-0.97) and neonatal death (relative risk, 0.50; 95% confidence interval, 0.39-0.65). When comparing relative risks in singleton vs twin pregnancies, there was sufficient evidence to suggest that twin pregnancies have a lower relative risk of cesarean delivery (P=.003), have sufficient adjustment for confounders, and have lower relative risks of admission to the neonatal intensive care unit (P=.005), stillbirths (P=.002), and neonatal death (P=.001) than singleton pregnancies. CONCLUSION In both singleton and twin pregnancies, gestational diabetes mellitus was associated with an increased risk of adverse maternal and perinatal outcomes. In twin pregnancies, gestational diabetes mellitus may have a milder effect on some adverse perinatal outcomes and may be associated with a lower risk of neonatal death.
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Affiliation(s)
- Elena Greco
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
| | - Maria Calanducci
- The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; The Harris Birthright Research Centre, King's College, London, United Kingdom
| | - Kypros H Nicolaides
- The Harris Birthright Research Centre, King's College, London, United Kingdom
| | - Eleanor V H Barry
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Mohammed S B Huda
- The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Malek AM, Wilson DA, Turan TN, Mateus J, Lackland DT, Hunt KJ. Hypertensive Disorders of Pregnancy and Pre-Pregnancy Hypertension with Subsequent Incident Venous Thromboembolic Events. Int J Environ Res Public Health 2024; 21:89. [PMID: 38248552 PMCID: PMC10815509 DOI: 10.3390/ijerph21010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
Hypertensive disorders of pregnancy (HDP) and pre-pregnancy hypertension contribute to maternal morbidity and mortality. We examined the association of HDP and pre-pregnancy hypertension with subsequent venous thromboembolic (VTE) events. The retrospective cohort study included 444,859 women with ≥1 live, singleton birth in South Carolina (2004-2016). Hospital and emergency department visit and death certificate data defined incident VTE, HDP, and pre-pregnancy hypertension. Birth certificate data also defined the exposures. Adjusted Cox proportional hazards methods modeled VTE events risk. Of the cohort, 2.6% of women had pre-pregnancy hypertension, 5.8% had HDP, 2.8% had both pre-pregnancy hypertension and HDP (both conditions), and 88.8% had neither condition. The risk of incident VTE events within one year of delivery was higher in women with HDP (hazard ratio [HR] = 1.62, 95% confidence interval [CI]: 1.15-2.29) and both conditions (HR = 2.32, 95% CI: 1.60-3.35) compared to those with neither condition as was the risk within five years for women with HDP (HR = 1.35, 95% CI: 1.13-1.60) and for women with both conditions (HR = 1.82, 95% CI: 1.50-2.20). One- and five-year risks did not differ in women with pre-pregnancy hypertension compared to women with neither condition. Compared to non-Hispanic White (NHW) women with neither condition, the incident VTE event risk was elevated within five years of delivery for NHW (HR = 1.29, 95% CI: 1.02-1.63; HR = 1.59, 95% CI: 1.16-2.17) and non-Hispanic Black (NHB; HR = 1.51, 95% CI: 1.16-2.96; HR = 2.08, 95% CI: 1.62-2.66) women with HDP and with both conditions, respectively, and for NHB women with pre-pregnancy hypertension (HR = 1.50, 95% CI: 1.09-2.07). VTE event risk was highest in women with HDP, and the event rates were higher in NHB women than in NHW women in the same exposure group.
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Affiliation(s)
- Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Dulaney A. Wilson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Tanya N. Turan
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Julio Mateus
- Atrium Health, Department of Obstetrics & Gynecology, Maternal-Fetal Medicine Division, Charlotte, NC 28204, USA
| | - Daniel T. Lackland
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
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Combellick JL, Basile Ibrahim B, Esmaeili A, Phibbs CS, Johnson AM, Patton EW, Manzo L, Haskell SG. Improving the Maternity Care Safety Net: Establishing Maternal Mortality Surveillance for Non-Obstetric Providers and Institutions. Int J Environ Res Public Health 2023; 21:37. [PMID: 38248502 PMCID: PMC10815856 DOI: 10.3390/ijerph21010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
The siloed nature of maternity care has been noted as a system-level factor negatively impacting maternal outcomes. Veterans Health Administration (VA) provides multi-specialty healthcare before, during, and after pregnancy but purchases obstetric care from community providers. VA providers may be unaware of perinatal complications, while community-based maternity care providers may be unaware of upstream factors affecting the pregnancy. To optimize maternal outcomes, the VA has initiated a system-level surveillance and review process designed to improve non-obstetric care for veterans experiencing a pregnancy. This quality improvement project aimed to describe the VA-based maternal mortality review process and to report maternal mortality (pregnancy-related death up to 42 days postpartum) and pregnancy-associated mortality (death from any cause up to 1 year postpartum) among veterans who use VA maternity care benefits. Pregnancies and pregnancy-associated deaths between fiscal year (FY) 2011-2020 were identified from national VA databases. All deaths underwent individual chart review and abstraction that focused on multi-specialty care received at the VA in the year prior to pregnancy until the time of death. Thirty-two pregnancy-associated deaths were confirmed among 39,720 pregnancies (PAMR = 80.6 per 100,000 live births). Fifty percent of deaths occurred among individuals who had experienced adverse social determinants of health. Mental health conditions affected 81%. Half (n = 16, 50%) of all deaths occurred in the late postpartum period (43-365 days postpartum) after maternity care had ended. More than half of these late postpartum deaths (n = 9, 56.2%) were related to suicide, homicide, or overdose. Integration of care delivered during the perinatal period (pregnancy through postpartum) from primary, mental health, emergency, and specialty care providers may be enhanced through a system-based approach to pregnancy-associated death surveillance and review. This quality improvement project has implications for all healthcare settings where coordination between obstetric and non-obstetric providers is needed.
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Affiliation(s)
- Joan L. Combellick
- Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA; (A.M.J.); (E.W.P.); (S.G.H.)
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA
- School of Nursing, Yale University, 400 West Campus Drive, Orange, CT 06477, USA; (B.B.I.); (L.M.)
| | - Bridget Basile Ibrahim
- School of Nursing, Yale University, 400 West Campus Drive, Orange, CT 06477, USA; (B.B.I.); (L.M.)
| | - Aryan Esmaeili
- Health Economics Resource Center (HERC), Palo Alto VA Medical Center, Menlo Park 795 Willow Road, Palo Alto, CA 94025, USA; (A.E.); (C.S.P.)
| | - Ciaran S. Phibbs
- Health Economics Resource Center (HERC), Palo Alto VA Medical Center, Menlo Park 795 Willow Road, Palo Alto, CA 94025, USA; (A.E.); (C.S.P.)
- Departments of Pediatrics and Health Policy, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA
| | - Amanda M. Johnson
- Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA; (A.M.J.); (E.W.P.); (S.G.H.)
| | - Elizabeth Winston Patton
- Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA; (A.M.J.); (E.W.P.); (S.G.H.)
- VA Boston Health Care System, 150 South Huntington Avenue, Boston, MA 02130, USA
- Department of Obstetrics and Gynecology, Chobanian & Avedisian School of Medicine, Boston University, 771 Albany St, Dowling 4, Boston, MA 02118, USA
| | - Laura Manzo
- School of Nursing, Yale University, 400 West Campus Drive, Orange, CT 06477, USA; (B.B.I.); (L.M.)
- US Army, AMEDD Student Detachment, 187th Medical Battalion, Joint Base San Antonio, San Antonio, TX 78234, USA
| | - Sally G. Haskell
- Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA; (A.M.J.); (E.W.P.); (S.G.H.)
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA
- School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, USA
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Hochberg A, Pare A, Badeghiesh AM, Baghlaf HA, Dahan MH. Pregnancy, delivery and neonatal outcomes among women with hypoparathyroidism-A population-based study. Clin Endocrinol (Oxf) 2023; 99:525-532. [PMID: 37694589 DOI: 10.1111/cen.14969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Data are inconclusive regarding pregnancy complications associated with maternal chronic hypoparathyroidism. Therefore, we aimed to compare pregnancy, delivery and neonatal outcomes in patients affected by chronic hypoparathyroidism to those without chronic hypoparathyroidism. DESIGN A retrospective population-based study utilising data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database over 11 years from 2004 to 2014 inclusively. Multivariate logistic regression was used to control for confounders. PATIENTS Patients with chronic hypoparathyroidism compared with those without. MEASUREMENTS Obstetric and neonatal outcomes. RESULTS We identified 204 pregnancies in mothers with chronic hypoparathyroidism and 9,096,584 pregnancies without chronic hypoparathyroidism. After adjusting for age, insurance plan type, obesity, chronic hypertension, thyroid disease, pregestational diabetes mellitus, and previous caesarean section, patients in the hypoparathyroidism group, compared with those without hypoparathyroidism, were found to have an increased rate of preterm birth (<37 weeks) (19.1% vs. 7.2%, aOR: 2.49, 95% confidence interval [CI]: 1.74-3.54, p < 0.0001, respectively); and blood transfusions (4.9% vs. 1.0%, aOR: 4.07, 95% CI: 2.15-7.73, p < -0.0001). Neonates to mothers with chronic hypoparathyroidism had a higher rate of congenital anomalies (4.4% vs. 0.4%, aOR: 6.50, 95% CI: 3.31-12.75, p < 0.0001), with comparable rates of small-for-gestational-age neonates and intrauterine foetal death. CONCLUSION This is the largest study of chronic hypoparathyroidism in pregnancy to date. We found significant increases in the rates of preterm birth, blood transfusions and congenital anomalies in chronic hypoparathyroidism. Our findings highlight the importance of identifying chronic hypoparathyroidism as a risk factor for pregnancy and neonatal complications, although it remains unknown if maintaining calcium in the target range will mitigate these risks.
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Affiliation(s)
- Alyssa Hochberg
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aurelie Pare
- Division of Endocrinology and Metabolism, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Ahmad M Badeghiesh
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Haitham A Baghlaf
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Safarzadeh S, Banihashemi F, Montazeri F, Roozbeh N, Darsareh F. Maternal and Neonatal Outcomes of Iron Deficiency Anemia: A Retrospective Cohort Study. Cureus 2023; 15:e51365. [PMID: 38292987 PMCID: PMC10825386 DOI: 10.7759/cureus.51365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Understanding the outcomes of anemia in pregnancy is critical. Since no study has been conducted regarding the maternal and neonatal outcomes of iron-deficiency anemia in Hormozgan province of Iran, this study aims to assess the maternal and neonatal outcomes of iron-deficiency anemia in women who gave birth in Hormozgan province from January 2020 to January 2022. METHODS We retrospectively assessed all singleton pregnant women who gave birth at a tertiary hospital in Bandar Abbas, Hormozgan province, Iran, for two years. We divided all women into iron-deficiency anemic and non-iron-deficiency anemic women. Iron-deficiency anemia was defined as hemoglobin less than 10.5 mg/dl at the time of admission without any other hemoglobinopathy, such as sickle cell anemia or thalassemia. Using electronic patient records, data were extracted from the Iranian Maternal and Neonatal Network (IMaN Net), a valid national system. Since the information of birth under 24 weeks of gestation is not recorded in this system, we excluded all deliveries under 24 weeks of gestation. The outcome measures of the study were demographic factors (age, education, residency place, access to prenatal care, smoking), obstetrical factors (parity, labor induction, fetal presentation, mode of delivery), and maternal and neonatal outcomes (the incidence of preeclampsia, gestational diabetes, placenta abruption, postpartum hemorrhage, maternal need for blood transfusion, maternal need for intensive care unit, preterm birth, low birth weight, intrauterine growth retardation, birth asphyxia, stillbirth, and neonatal intensive care admission). Chi-square tests were used to compare differences between iron-deficiency anemic and non-iron-deficiency anemic women. Logistic regression models were used to assess the effect of iron-deficiency anemia on maternal and neonatal outcomes. The result was presented as odds ratio (OR) or adjusted odds ratio (aOR) after adjusting for covariates and a 95% confidence interval (CI). Results: The incidence of iron-deficiency anemia was 2.97%. Education and residency were among the demographic factors that differed significantly between groups. Iron-deficiency anemia was more frequent in those with higher education and women who lived in rural areas. In terms of obstetrical factors, method of delivery was the only significantly different factor between groups. Iron-deficiency anemic mothers had substantially more instrumental deliveries than non-iron-deficiency anemic mothers (4.3% vs. 0.8%), while the incidence of cesarean section was lower. Based on logistic regression in terms of maternal and neonatal outcomes, iron-deficiency anemic women had a substantially higher risk of the need for maternal blood transfusion (aOR: 6.54, 95%CI: 4.72-8.15), postpartum hemorrhage (aOR: 1.54, 95%CI: 0.71-2.11), preterm birth (aOR: 0.98, 95%CI: 0.45-1.13), low birth weight (aOR: 1.04, 95%CI: 0.78-2.01), intrauterine growth retardation (aOR: 1.30, 95%CI: 0.99-2.10), and neonatal intensive care admission (aOR: 1.06, 95%CI: p.52-2.72), after adjusting for educational level, residency place, and method of delivery. CONCLUSIONS Despite the higher incidence of postpartum hemorrhage and maternal blood transfusion, we found no increase in maternal intensive care unit admission risk. Regarding neonatal outcomes, iron-deficiency anemia was linked to preterm birth, low birth weight, intrauterine growth retardation, and neonatal intensive care admission.
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Affiliation(s)
- Sanaz Safarzadeh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IRN
| | - Farzaneh Banihashemi
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IRN
| | - Farideh Montazeri
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IRN
| | - Nasibeh Roozbeh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IRN
| | - Fatemeh Darsareh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IRN
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Overton E, Wen T, Friedman AM, Azad H, Nhan-Chang CL, Booker WA, Khoury-Collado F, Mourad M. Outcomes associated with peripartum hysterectomy in the setting of placenta accreta spectrum disorder. Am J Obstet Gynecol MFM 2023; 5:101174. [PMID: 37802412 DOI: 10.1016/j.ajogmf.2023.101174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Although peripartum hysterectomy for placenta accreta spectrum disorder is known to be associated with complications at the time of delivery, there are limited data on postpartum outcomes and readmission risk in this population. OBJECTIVE This study aimed to analyze risks for adverse outcomes and postpartum readmissions in the setting of peripartum hysterectomy for placenta accreta spectrum disorder by severity of placenta accreta spectrum disorder subcategory. STUDY DESIGN Using the 2016-2020 Nationwide Readmissions Database, this retrospective cohort study identified peripartum hysterectomies with a diagnosis of placenta accreta spectrum disorder. The primary exposure was placenta accreta spectrum disorder, subcategorized as placenta accreta vs increta/percreta. The primary outcome was readmission rate and delivery complications. Complications evaluated included the following: (1) nontransfusion severe maternal morbidity (ntSMM), (2) venous thromboembolism, (3) reoperation, (4) intraoperative complications, (5) hemorrhage, (6) sepsis, and (7) surgical site complications. We additionally evaluated delivery hospitalization and readmission mean length of stay, and hospital costs. Unadjusted and adjusted logistic regression models were fit for outcomes adjusting for clinical, demographic, and hospital factors. The association measures were expressed as unadjusted and adjusted odds ratios with 95% confidence intervals. RESULTS Between 2016 and 2020, 7864 hysterectomies during a delivery hospitalization with a diagnosis of placenta accreta spectrum disorder were identified (66.5% with placenta accreta and 33.5% with placenta increta/percreta diagnoses). The overall 60-day all-cause readmission rate was 7.3%. Most readmissions (57.2%) occurred within 10 days of hospital discharge. Compared with peripartum hysterectomy with a diagnosis of placenta accreta, hysterectomies with placenta increta/percreta diagnoses carried significantly increased risk of 60-day readmission (adjusted odds ratio, 1.31; 95% confidence interval, 1.01-1.71), inpatient mortality (odds ratio, 13.23; 95% confidence interval, 3.35-52.30), nontransfusion severe maternal morbidity (adjusted odds ratio, 1.43; 95% confidence interval, 1.20-1.71), intraoperative complications (adjusted odds ratio, 2.31; 95% confidence interval, 1.93-2.77), and surgical site complications (adjusted odds ratio, 1.55; 95% confidence interval, 1.23-1.95). The median length of stay during delivery hospitalization was longer for placenta increta/percreta (5.8 days; 95% confidence interval, 5.4-6.1) than for placenta accreta (4.2 days; 95% confidence interval, 4.1-4.3; P<.05). In addition, delivery hospitalization costs were higher in cases of placenta increta/percreta (median, $30,686; 95% confidence interval, $28,922-$32,449) than placenta accreta (median, $21,321; 95% confidence interval, $20,480-$22,163). CONCLUSION Complication and readmission risks after peripartum hysterectomy with placenta accreta spectrum disorder are high. Compared with patients with placenta accreta, patients with placenta increta/percreta had increased risk for delivery and postoperative complications and postpartum readmission, and increased costs and length of stay.
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Affiliation(s)
- Eve Overton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad).
| | - Timothy Wen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA (Dr Wen)
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Hooman Azad
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Chia-Ling Nhan-Chang
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Fady Khoury-Collado
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
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Tan J, Fei H, Chen L, Zhu X. The association of hyperuricemia and maternal and fetal outcomes among pregnant women: a meta-analysis. J Matern Fetal Neonatal Med 2023; 36:2212830. [PMID: 37193631 DOI: 10.1080/14767058.2023.2212830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This meta-analysis aimed to investigate the relationship between hyperuricemia and maternal and neonatal complications in pregnant women. METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Library from the databases' inception to August 12, 2022. We included studies that reported results on the association between hyperuricemia and maternal and fetal outcomes among pregnant women. Using the random-effects model, the pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated for each outcome analysis. RESULTS A total of 7 studies, including 8104 participants, were included. The pooled OR for pregnancy-induced hypertension (PIH) was 2.61 [0.26, 26.56] (z = 0.81, p = .4165; I2 = 96.3%). The pooled OR for preterm birth was 2.52 [1.92, 3.30] (z = 6.64, p < .0001; I2 = 0%). The pooled OR for low birth weight (LBW) was 3.44 [2.52, 4.70] (z = 7.77, p < .0001; I2 = 0%). The pooled OR for small gestational age (SGA) was 1.81 [0.60, 5.46] (z = 1.06, p = .2912; I2 = 88.6%). CONCLUSION Results of this meta-analysis indicate a positive relationship between hyperuricemia and PIH, preterm birth, LBW, and SGA in pregnant women.
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Affiliation(s)
- Jie Tan
- Department of Nutrition, Hangzhou Women's Hospital, Hangzhou, China
| | - Huali Fei
- Department of Reproduction and Family Planning, Hangzhou Women's Hospital, Hangzhou, China
| | - Lumeng Chen
- Department of Outpatient, Hangzhou Women's Hospital, Hangzhou, China
| | - Xuhong Zhu
- Department of Ministry of Women's health, Hangzhou Women's Hospital, Hangzhou, China
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Greiner KS, Rincón M, Derrah KL, Burwick RM. Elevated liver enzymes and adverse outcomes among patients with preeclampsia with severe features. J Matern Fetal Neonatal Med 2023; 36:2160627. [PMID: 36597834 DOI: 10.1080/14767058.2022.2160627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The rate of preeclampsia with severe features has increased. Previous studies have shown elevated liver enzymes are an indicator of worsening hypertensive disease of pregnancy and adverse outcomes, therefore leading to their inclusion as a diagnostic criterion for severe features of preeclampsia. Despite this, there are limited data to support an aspartate aminotransferase (AST) or alanine aminotransferase (ALT) concentration ≥ two times the upper limit of normal as the critical point at which maternal harm from ongoing pregnancy exceeds neonatal harm from delivery. The objective of this study is to evaluate the association between elevated liver enzymes and maternal and neonatal outcomes among patients with preeclampsia with severe features. METHODS Retrospective cohort study among hypertensive patients who delivered ≥23 weeks' gestation at Oregon Health & Science University (October 2013-September 2018). Those with preeclampsia with severe features (including chronic hypertension with superimposed preeclampsia meeting criteria for severe features) were included after a screening of ICD-9 and ICD-10 codes and chart validation. The primary exposure was elevated liver enzymes prior to delivery, according to the American College of Obstetricians and Gynecologists' criteria for severe features of preeclampsia: aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥2x the upper limit of normal (above threshold liver function tests [LFTs]). Primary outcomes included adverse maternal and neonatal outcomes. Differences were analyzed by Chi-squared, Fisher's exact, t-test, and logistic regression, with α = 0.05. RESULTS Of 11,825 deliveries, 319 (2.7%) met inclusion criteria and had preeclampsia with severe features. Of these, 44 (13.8%) had above threshold LFTs. Adverse maternal outcomes were no different in those with above threshold LFTs compared to those with below threshold LFTs. The unadjusted odds of an adverse neonatal outcome were 2.08 times greater in patients with above threshold LFTs (95% CI: 1.04-4.14), and 2.43 times greater when adjusting for maternal characteristics (95% CI: 1.17-5.04) compared to those with below threshold LFTs. However, the association between above threshold LFTs and adverse neonatal outcomes became non-significant after adjustment for gestational age at delivery (OR: 1.54, 95% CI: 0.63-3.76). CONCLUSION Among patients with preeclampsia with severe features, above threshold LFTs are not independently associated with an increased risk of adverse maternal or neonatal outcomes. Adverse neonatal outcomes in patients with preeclampsia with severe features and above threshold LFTs are driven by earlier gestational age at delivery. Prospective studies are needed to guide delivery timing in patients with preeclampsia and elevated liver enzymes. BRIEF RATIONALE The criteria for elevated liver function tests (greater than two times the upper limit of normal) are widely accepted among obstetricians to diagnose a severe feature of preeclampsia. However, these criteria are based on expert opinion and extrapolated from data on patients with HELLP syndrome. Since preterm delivery of the neonate is recommended for preeclampsia with severe features, the threshold used to define severe liver enzyme elevation has a direct impact on neonatal outcomes. Therefore, the goal of our study was to determine if patients with preeclampsia with severe features and a pre-delivery AST or ALT level ≥ two times the upper limit of normal have worse maternal and neonatal outcomes compared to those with an AST and ALT below this level.
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Affiliation(s)
- Karen S Greiner
- Department of Obstetrics and Gynecology, Kaiser Permanente San Francisco, San Francisco, CA, USA
| | - Mónica Rincón
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Kelli L Derrah
- Department of Pediatrics, University of California, Davis, Davis, CA, USA
| | - Richard M Burwick
- San Gabriel Valley Perinatal Medical Group, Division of Maternal Fetal Medicine, Pomona Valley Hospital Medical Center, Pomona, CA, USA
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Hao X, Li C, Shao C, Yang F, Xie H, Hong X, Wang J, Li S, Li B, Chen D, Huang X, Li J, Liu X, Zhang J, Qiu H, Fan E, Brodie D, Wang H, Wang L, Hou X. Obstetric management strategies for pregnant patients receiving extracorporeal membrane oxygenation and associated maternal-fetal outcomes: a multicentre cohort study. Br J Anaesth 2023; 131:e147-e150. [PMID: 37716886 DOI: 10.1016/j.bja.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023] Open
Affiliation(s)
- Xing Hao
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chenglong Li
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chengcheng Shao
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Feng Yang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haixiu Xie
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyang Hong
- Pediatric Intensive Care Unit, Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Jinquan Wang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shuanglei Li
- Division of Adult Cardiac Surgery, Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Binfei Li
- Department of Anesthesiology, Zhongshan People's Hospital (Zhongshan Hospital of Sun Yat-Sen University), Zhongshan, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobo Huang
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Li
- Department of ECLS, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojun Liu
- Department of Intensive Care, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinsong Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Nanjing Medical University, People's Hospital of Jiangsu Province, Nanjing, China
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Brodie
- Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Hong Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Liangshan Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Lenin A, Abraham K, David LS, Tirkey RS, Mani T, Jasmine S, Sathyendra S. Comparison between the demographic shift clinical severity and outcome of the first two waves of COVID-19 in pregnancy in a tertiary hospital in India. Int J Gynaecol Obstet 2023; 163:586-593. [PMID: 37184055 DOI: 10.1002/ijgo.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To study and compare the maternal and neonatal outcomes of COVID-19 in pregnancy during the two waves of the pandemic in India. METHODS This observational, retrospective cohort study on pregnant women with SARS-CoV-2 infection was conducted in a 2700-bed tertiary referral center in South India from March 1, 2020 to June 30 2021. The clinical presentation, severity, and maternal and neonatal outcomes of COVID-19 were compared between the two waves. RESULTS A total of 623 pregnant women tested positive for SARS-CoV-2 infection in our institute; 379 (60.8%) were diagnosed during the first wave and 244 (39.2%) in the second wave. Most of the affected women (81.1%) were in their third trimester. Maternal mortality rate was 823 per 100 000 live births. Composite maternal outcome (increasing requirement for ventilation, pulmonary embolism, disease progression) were more pronounced during the second wave (2.1% vs 6.1%). Between the two waves, both maternal (1 vs 3; P = 0.162) and perinatal (3.2% vs 6.7%; P = 0.065) deaths were higher during the second wave. The cesarean section rate was high during the first wave (48% vs 32.4%; P < 0.001). Preterm births were comparable between the two waves (19.5% vs 22%; P < 0.500). CONCLUSION The women presented with more severe illness during the second wave of COVID-19. There was higher perinatal mortality, but the maternal mortality was similar between the two waves.
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Affiliation(s)
- Audrin Lenin
- Department of Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Kavitha Abraham
- Department of Obstetrics & Gynaecology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Liji Sarah David
- Department of Obstetrics & Gynaecology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Richa Sasmita Tirkey
- Department of Obstetrics & Gynaecology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Thenmozhi Mani
- Department of Biostatistics, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Sudha Jasmine
- Department of Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Soumya Sathyendra
- Department of Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
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Yanachkova VE, Staynova R, Stoev S, Kamenov Z. Меtformin-associated maternal and neonatal outcomes in women with gestational diabetes - a retrospective cohort study. Ginekol Pol 2023; 95:259-265. [PMID: 37842989 DOI: 10.5603/gpl.91632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/04/2023] [Accepted: 08/22/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES To assess the maternal and neonatal outcomes in women with GDM treated with metformin, medical nutrition therapy (MNT) or insulin. MATERIAL AND METHODS The current retrospective cohort study includes data from 233 women diagnosed with GDM who gave birth between January 2017 and January 2019 at an obstetrics and gynecology hospital in Sofia, Bulgaria. Patients were assigned to three groups, according to the treatment approach - metformin group (n = 70), insulin group (n = 40), and MNT group (n = 123). Values of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) have been evaluated at diagnosis of GDM and the third trimester of pregnancy. A comparative analysis of pregnancy outcomes and short-term neonatal characteristics in the investigated groups has been performed. RESULTS Women indicated for pharmacological treatment (metformin or insulin) had significantly higher BMI (p < 0.01), FPG (p < 0.001), and HbA1c levels (p < 0.001) at baseline. However, during pregnancy, patients treated with metformin showed a significantly lower BMI (p < 0.01), FPG (p < 0.01), and HbA1c (p < 0.01). Neonates born to metformin-treated mothers had lower birth weight compared to those born to women in the MNT and insulin groups (metformin vs MNT, p < 0.001; metformin vs insulin, p = 0.03). The lowest incidence of newborns with macrosomia and neonatal hypoglycemia has been observed in the metformin cohort. Not a single newborn with an Apgar score under 7 has been identified in the metformin group. CONCLUSIONS According to the current analysis, women with GDM treated with metformin demonstrated better maternal and neonatal outcomes. No short-term complications in newborns have been associated with metformin use during pregnancy.
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Affiliation(s)
- Vesselina Evtimova Yanachkova
- Department of Endocrinology, Specialized Hospital for Active Treatment of Obstetrics and Gynaecology "Dr Shterev", Sofia, Bulgaria, Bulgaria.
| | - Radiana Staynova
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria
| | - Svetoslav Stoev
- Department of Pharmaceutical Sciences and Social Pharmacy, Faculty of Pharmacy, Medical University of Pleven, Bulgaria, Bulgaria
| | - Zdravko Kamenov
- Clinic of Endocrinology, Alexandrovska University Hospital, Medical University of Sofia, Bulgaria, Bulgaria
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Incognito GG, Distefano REC, Campo G, Gulino FA, Gulisano C, Gullotta C, Gullo G, Cucinella G, Tuscano A, Bruno MT, Palumbo M. Comparison of Maternal and Neonatal Outcomes between SARS-CoV-2 Variants: A Retrospective, Monocentric Study. J Clin Med 2023; 12:6329. [PMID: 37834972 PMCID: PMC10573122 DOI: 10.3390/jcm12196329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
The impact of SARS-CoV-2 variants on maternal and neonatal outcomes during pregnancy is still poorly understood, and the emergence of different variants has further complicated our understanding of the virus's effects. This retrospective, monocentric study aimed to fill this knowledge gap by analyzing the outcomes of pregnant women with acute SARS-CoV-2 infection caused by the Alpha, Delta, and Omicron variants. The study, conducted between December 2020 and March 2022 at San Marco Hospital, included 313 pregnant women with confirmed SARS-CoV-2 infection. The results showed that the Delta variant was associated with a significantly higher incidence of adverse outcomes, such as premature births, maternal intensive care unit admission, intrauterine growth restriction, and small for gestational age infants. Additionally, the Delta variant was linked to lower Apgar scores, higher maternal and fetal mortality rates, and increased levels of various biomarkers indicating more severe illness. Finally, the Delta variant also presented a greater possibility of vertical transmission. These findings underscore the complexity of understanding the impact of SARS-CoV-2 on pregnancy outcomes, especially considering the distinctive characteristics of different variants. By better understanding the specific impacts of each variant, appropriate preventive measures and management strategies can be implemented to optimize maternal and neonatal outcomes.
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Affiliation(s)
- Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95100 Catania, Italy; (G.G.I.); (R.E.C.D.); (G.C.); (C.G.); (A.T.); (M.T.B.); (M.P.)
| | - Rosario Emanuele Carlo Distefano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95100 Catania, Italy; (G.G.I.); (R.E.C.D.); (G.C.); (C.G.); (A.T.); (M.T.B.); (M.P.)
| | - Giorgia Campo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95100 Catania, Italy; (G.G.I.); (R.E.C.D.); (G.C.); (C.G.); (A.T.); (M.T.B.); (M.P.)
| | - Ferdinando Antonio Gulino
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adults and Developmental Age, University Hospital “G. Martino”, 98100 Messina, Italy
| | - Chiara Gulisano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95100 Catania, Italy; (G.G.I.); (R.E.C.D.); (G.C.); (C.G.); (A.T.); (M.T.B.); (M.P.)
| | - Chiara Gullotta
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy;
| | - Giuseppe Gullo
- Azienda Ospedaliera Ospedali Riuniti (AOOR) Villa Sofia Cervello, University of Palermo, 90133 Palermo, Italy; (G.G.); (G.C.)
| | - Gaspare Cucinella
- Azienda Ospedaliera Ospedali Riuniti (AOOR) Villa Sofia Cervello, University of Palermo, 90133 Palermo, Italy; (G.G.); (G.C.)
| | - Attilio Tuscano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95100 Catania, Italy; (G.G.I.); (R.E.C.D.); (G.C.); (C.G.); (A.T.); (M.T.B.); (M.P.)
| | - Maria Teresa Bruno
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95100 Catania, Italy; (G.G.I.); (R.E.C.D.); (G.C.); (C.G.); (A.T.); (M.T.B.); (M.P.)
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95100 Catania, Italy; (G.G.I.); (R.E.C.D.); (G.C.); (C.G.); (A.T.); (M.T.B.); (M.P.)
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Blum M, Hochler H, Sela HY, Peled T, Ben-Zion O, Weiss A, Lipschuetz M, Rosenbloom JI, Grisaru-Granovsky S, Rottenstreich M. Failed vacuum and preterm delivery risk in the subsequent pregnancy: a multicenter retrospective cohort study. Am J Obstet Gynecol MFM 2023; 5:101121. [PMID: 37558127 DOI: 10.1016/j.ajogmf.2023.101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Second-stage cesarean delivery is associated with subsequent preterm delivery. Failed vacuum-assisted delivery is a subgroup of second-stage cesarean delivery in which the fetal head is engaged deeper in the pelvis and, thus, is associated with an increased risk of short-term maternal complications. OBJECTIVE This study aimed to investigate the maternal and neonatal outcomes of women at their subsequent delivery after a second-stage cesarean delivery with failed vacuum-assisted extraction vs after a second-stage cesarean delivery without a trial of vacuum-assisted extraction. STUDY DESIGN This was a multicenter retrospective cohort study. The study population included all women in their subsequent pregnancy after a second-stage cesarean delivery who delivered in all university-affiliated obstetrical centers (n=4) in a single geographic area between 2003 and 2021. Maternal and neonatal outcomes of women who had second-stage cesarean delivery after a failed vacuum-assisted delivery were compared with women who had second-stage cesarean delivery without a trial of vacuum-assisted delivery. The primary outcome of this study was preterm delivery at <37 weeks of gestation. The secondary outcomes were vaginal birth rate and other adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression modeling. RESULTS During the study period, 1313 women met the inclusion criteria, of whom 215 (16.4%) had a history of failed vacuum-assisted delivery at the previous delivery and 1098 (83.6%) did not. In univariate analysis, women with previously failed vacuum-assisted delivery had similar preterm delivery rates (<37, <34, <32, and <28 weeks of gestation), a successful trial of labor after cesarean delivery rates, uterine rupture, and hysterectomy. However, multivariable analyses controlling for confounders showed that a history of failed vacuum-assisted delivery is associated with a higher risk of preterm delivery at <37 weeks of gestation (adjusted odds ratio, 2.05; 95% confidence interval, 1.11-3.79; P=.02), but not with preterm delivery at <34 or <32 weeks of gestation. CONCLUSION Among women with a previous second-stage cesarean delivery, previously failed vacuum-assisted delivery was associated with an increased risk of preterm delivery at <37 weeks of gestation in the subsequent birth.
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Affiliation(s)
- Maayan Blum
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Hila Hochler
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Hochler, Lipschuetz, and Rosenbloom).
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Tzuria Peled
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Ori Ben-Zion
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Ari Weiss
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Michal Lipschuetz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Hochler, Lipschuetz, and Rosenbloom); Faculty of Medicine, Henrietta Szold Hadassah - Hebrew University School of Nursing, Jerusalem, Israel (Dr Lipschuetz)
| | - Joshua Isaac Rosenbloom
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Hochler, Lipschuetz, and Rosenbloom)
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich); Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel (Dr Rottenstreich)
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Khogali HI, Al-Bluwi GSM, Guy Pedo V, Al Dhanhani AM. Maternal and fetal health outcomes in systemic lupus erythematosus pregnancies in the Emirati population: A comparative study. Lupus 2023; 32:1453-1461. [PMID: 37786253 DOI: 10.1177/09612033231204650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
OBJECTIVES To evaluate adverse pregnancy outcomes in patients with systemic lupus erythematosus (SLE), compare their maternal and fetal outcomes with those of age-matched pregnant women without SLE, and identify factors linked to increased risks of adverse outcomes. METHODS Medical records from Tawam Hospital were reviewed retrospectively to identify patients with SLE and a history of pregnancy. Demographics, clinical variables, and maternal and fetal outcomes were obtained. A one-to-one age-matched healthy control group was randomly selected. The outcomes and odd ratios of women with and without SLE were compared, and factors associated with adverse pregnancy outcomes were examined. RESULTS The outcomes of 78 SLE pregnancies in 39 women were analyzed. Adverse maternal outcomes, such as gestational diabetes mellitus (GDM), occurred in 32% of pregnancies, whereas adverse fetal outcomes, such as low-birth weight and preterm deliveries, occurred in 51% of pregnancies. Pregnant women with SLE had a 5-fold higher risk of GDM, had higher odds of maternal hypertension, and were more likely to deliver through cesarean section than those without SLE. Preterm deliveries and low-birth weight were also more common in SLE pregnancies. Steroid use during pregnancy was significantly associated with an increased risk of GDM development. Lupus nephritis, maternal hypertension, pre-eclampsia, and GDM were linked to preterm deliveries. CONCLUSION Pregnant women with SLE were at a higher risk for adverse maternal and fetal outcomes than age-matched pregnant women without SLE. These findings can guide clinical management and emphasize the need for close monitoring of SLE pregnancies.
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Affiliation(s)
| | - Ghada S M Al-Bluwi
- Internal Medicine Department, College of Medicine & Health Sciences, UAE University, Al Ain, UAE
| | - Virgie Guy Pedo
- Internal Medicine Department, College of Medicine & Health Sciences, UAE University, Al Ain, UAE
| | - Ali M Al Dhanhani
- Internal Medicine Department, College of Medicine & Health Sciences, UAE University, Al Ain, UAE
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Sara A, Hunker DF. An Initiative to Increase Nurse Knowledge and Decrease Postpartum Readmissions for Preeclampsia. Nurs Womens Health 2023; 27:337-343. [PMID: 37572696 DOI: 10.1016/j.nwh.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/20/2023] [Accepted: 07/12/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To increase nurses' knowledge using innovative education and to improve maternal outcomes by reducing postpartum readmission rates of women with preeclampsia. DESIGN Quality improvement project implementing escape room-style education for nurses. SETTING/LOCAL PROBLEM A large tertiary hospital in southeastern Michigan with initial postpartum readmission rates of women with preeclampsia exceeding national averages. PARTICIPANTS Registered nurses (n = 71) working on the hospital postpartum unit; 70 completed the project. INTERVENTION/MEASUREMENTS Participants completed a knowledge survey on the care and management of women in the postpartum period with preeclampsia and then engaged in an escape room game scenario involving an increasingly acute case of a woman with preeclampsia. Debriefing occurred after the education, and then participants completed the same survey. Using data collected after the project, we compared postpartum readmission rates of women with preeclampsia to the median national average of 3.55%. RESULTS Nurse knowledge increased by 10.5% from the pre- to posttest period. For the 2-month project time period, the average readmission rate was 1.49%. CONCLUSION Offering innovative, interactive education to nurses, such as an escape room game, appeared to be an effective method to increase nurses' knowledge and may have improved maternal outcomes, as demonstrated through a readmission rate lower than the median national average. Further projects using longer time periods are needed to understand the true impact of the education on readmission rates.
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Karimi N, Samiee N, Moradi Y. The association between periodontal disease and risk of adverse maternal or neonatal outcomes: A systematic review and meta-analysis of analytical observational studies. Health Sci Rep 2023; 6:e1630. [PMID: 37867783 PMCID: PMC10587389 DOI: 10.1002/hsr2.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Background and Aim The aim of this meta-analysis was to find the association between periodontal disease (PD) and the risk of adverse pregnancy outcomes, including Pre-eclampsia (PE), premature rupture of the amniotic sac, gestational diabetes (GDM), or low birth weight (LBW) in pregnant women, which should be investigated in a systematic meta-analysis. Methods Studies that reported the association between PD and pregnancy or neonatal outcomes and were published from January 1990 to December 2022, were identified by an extensive search in PubMed (Medline), Scopus, Web of Sciences, and Medline (Elsevier). After retrieving the studies, the screening stage was performed based on their titles, abstracts, and full texts, and after selecting the final articles, their information was extracted and their quality was assessed using the Newcastle Ottawa Scale checklist. Results Pregnant women with PD had a 1.39 higher chance of developing GDM than those who did not have the infection (risk ratio [RR]: 1.39; 95% confidence interval [CI]: 1.21-1.61; I square: 49.67%; p: 0.03). Additionally, the pooled RR of LBW was 2.19, which indicates that pregnant women with PD had a 2.19-fold higher risk of LBW than pregnant women who do not have the infection (RR: 2.19; 95% CI: 1.82-2.64; I square: 0.00%; p: 0.65). The relationship between the risk of PE and the existence of PD was examined in 33 cohort and case-control studies for this meta-analysis. These results were combined, and the pooled RR was 1.43. This indicates that pregnant women with PD are 1.43 times more likely to experience PE than pregnant women without PD (RR: 1.43; 95% CI: 1.32-1.54; I square: 82.64%; p: 0.00). Conclusion According to the findings of the current meta-analysis, PD may contribute to a higher risk of poor maternal and newborn outcomes in pregnant women.
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Affiliation(s)
- Newsha Karimi
- Student Research Committee, Facualty of DentistryKurdistan University of Medical SciencesSanandajIran
| | - Negin Samiee
- Oral and Maxillofacial Medicine Department, Facualty of DentistryKurdistan University of Medical SciencesSanandajIran
| | - Yousef Moradi
- Social Determinant of the Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
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Johnson A, Vaithilingan S, Avudaiappan SL. The Interplay of Hypertension and Anemia on Pregnancy Outcomes. Cureus 2023; 15:e46390. [PMID: 37927714 PMCID: PMC10620472 DOI: 10.7759/cureus.46390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Background Anemia and pregnancy-induced hypertension (PIH) are two significant high-risk conditions that can have a profound impact on maternal health during pregnancy. The scarcity of studies investigating the potential links and interactions between these two conditions adds to the gap in our understanding of their combined impact on pregnant women. This study aimed to assess the impact of PIH in conjunction with anemia and without anemia on pregnancy outcomes. Methods A prospective study was conducted among 150 primi pregnant women (third trimester of pregnancy) from a secondary-care hospital (Government General Headquarters Hospital, Cuddalore) in Tamil Nadu, India. The study population was selected using a purposive sampling technique. Data were collected using a structured questionnaire to assess sociodemographic characteristics, dietary patterns, and outcomes of pregnancy. Clinical parameters such as blood pressure were measured using a sphygmomanometer, and hemoglobin and urine tests for protein were obtained from the patient's medical records. Results The result showed that out of 150 primi pregnant women, 73 (49%) had PIH and 77 (51%) experienced both PIH and anemia. On comparing the outcomes, pregnant women with PIH accompanied by anemia exhibited developing preeclampsia (p<0.001), encountered maternal complications (p=0.034), delivered preterm babies (p=0.03), and gave birth to low-birth-weight babies (p<0.001), and their newborns admitted to the NICU (p=0.02). Additionally, pregnant women with both PIH and anemia demonstrated significantly higher levels of systolic blood pressure after delivery (p=0.009). Conclusion The study calls for the immediate attention of healthcare providers for vigilant monitoring and addressing anemia in conjunction with PIH to improve maternal and neonatal outcomes.
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Affiliation(s)
- Alby Johnson
- Department of Obstetrics and Gynaecological Nursing, Vinayaka Mission's Research Foundation (DU), Salem, IND
| | - Sasi Vaithilingan
- Department of Child Health Nursing, Vinayaka Mission's College of Nursing, Puducherry, IND
| | - Seetha Lakshmi Avudaiappan
- Department of Nursing Foundation, Sri Ramachandra College of Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Williams DM, Moore S, Coventry J, Nana M. Comparing pre-pregnancy counselling, diabetes knowledge and risk factors for adverse outcomes in women with type 1 or type 2 diabetes mellitus in Wales: A prospective multi-centre observational study. Diabet Med 2023; 40:e15161. [PMID: 37289014 DOI: 10.1111/dme.15161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023]
Affiliation(s)
| | | | | | - Melanie Nana
- Department of Women & Children's Health, King's College London, London, England
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Seif KE, Tadbiri H, Mangione M, Wolfe A, Whitaker K, Desai A, Turan S. The impact of trimester of COVID-19 infection on pregnancy outcomes after recovery. J Perinat Med 2023; 51:868-873. [PMID: 37134272 DOI: 10.1515/jpm-2022-0568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/05/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Many physiological adaptations occur during pregnancy. It is not currently known how timing of COVID-19 infection impacts pregnancy. We hypothesize that maternal and neonatal outcomes are different if COVID-19 infection occurs in different trimesters of pregnancy. METHODS This retrospective cohort study was conducted from 3/2020 to 6/2022. Pregnant patients with a positive COVID-19 infection more than 10 days before delivery (COVID-recovered) were identified and grouped by trimester of infection. Demographics and maternal, obstetric, and neonatal outcomes were analyzed. ANOVA, Wilcoxon rank-sum test, Pearson's chi-squared test, and Fisher's exact test were used to compare continuous and categorical data. RESULTS A total of 298 COVID-recovered pregnant patients were identified. Of those, 48 (16 %) were infected in the 1st trimester, 123 (41 %) in the 2nd, and 127 (43 %) in the 3rd. There were no significant demographic differences between the study groups. Vaccination status was similar. Hospital admission rate and the need for oxygen therapy while infected were significantly higher in patients with 2nd or 3rd trimester infection (18 % & 20 % vs. 2 % and 13 % & 14 % vs. 0 %, respectively). Rates of preterm birth (PTB) and extreme PTB were higher in the 1st trimester infection group. Infants born to mothers infected in the 2nd trimester had more neonatal sepsis workups (22 % vs. 12 % & 7 %). Other outcomes were similar between groups. CONCLUSIONS First trimester COVID-recovered patients were more likely to have a preterm birth despite having lower rates of hospital admission and oxygen supplementation while infected than patients who recovered from a 2nd or 3rd trimester infection.
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Affiliation(s)
- Karl E Seif
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hooman Tadbiri
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mary Mangione
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexa Wolfe
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kiara Whitaker
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrea Desai
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sifa Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
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Dixit P, Mishra TK, Nargawe D, Singh S. Maternal and Perinatal Outcome in Patients With Eclampsia: A Study Done at a Tertiary Care Centre. Cureus 2023; 15:e45971. [PMID: 37900531 PMCID: PMC10600615 DOI: 10.7759/cureus.45971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Background One of the leading causes contributing to morbidity and mortality globally is attributed to eclampsia. Hence, it is vital to comprehensively review each female having eclampsia and to evaluate the factors that govern the outcomes in females with eclampsia. Aim To decode the fetal and maternal outcomes in subjects having eclampsia and to evaluate various factors that govern the outcomes. Methods This retrospective cohort and epidemiological study commenced at the Department of Obstetrics and Gynaecology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, in January 2016 till April 2017, and included females that either developed eclampsia in hospital stay duration or presented with pre-existing eclampsia. In included females, various fetal and maternal parameters were assessed along with the outcome of pregnancy. The institutional data records and the database were also used to determine the prevalence and incidence of eclampsia. Baseline maternal parameters were recorded from the already-existing institute data. These included the gestational age (in years), socioeconomic status, educational attainment, parity, gravidity, and the number of weeks of gestation present at the time of delivery. Antenatal care data assessed were blood pressure recordings, any proteinuria documented in the data, and the number of antenatal visits by the subjects. Statistical analysis was performed to assess both parameters. Results In the current investigation, there were 0.34% eclampsia cases among females visiting the institution for deliveries. Incidences of stillbirth were seen in 19.04% and 8% of study participants, respectively. We found 9.52% (n=4) of female infants to have perished from eclampsia. Preterm births, a delayed start to the treatment, and insufficient care were all linked to poor foetal and mother outcomes. The longer the period between the beginning of a fit and delivery, the greater the likelihood of unfavourable results. Seizure onset before or after birth, parity, or subject age had no impact on mother or foetal health. The p-value for statistical significance was kept at 0.05. Conclusion Most of the research participant women, had intrapartum eclampsia, postpartum eclampsia, and antepartum eclampsia, based on the time of the convulsions in relation to the labor. It was highlighted that there was no conclusive evidence linking the date of the fit's beginning to unfavourable results or an elevated risk of complications. Neonatal mortality and stillbirth were observed with vaginal delivery in eclampsia cases. Outcomes in eclampsia can be improved by early treatment initiation, timely and appropriate referral, early disease recognition, and appropriate antenatal care.
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Affiliation(s)
- Pratibha Dixit
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Ratlam, IND
| | - Tarunendra K Mishra
- Department of General Medicine, Government Medical College and Hospital, Ratlam, IND
| | - Devendra Nargawe
- Department of Pediatrics, Government Medical College and Hospital, Ratlam, IND
| | - Sandeep Singh
- Department of General Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
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Safavi Ardabili N, Rahimi F, Ranjbar A, Montazeri F, Darsareh F. Maternal and Neonatal Outcomes of Sub-clinical Hypothyroidism Treated With Levothyroxine in Pregnancy: A Retrospective Cohort Study. Cureus 2023; 15:e45352. [PMID: 37849597 PMCID: PMC10578098 DOI: 10.7759/cureus.45352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION The effect of sub-clinical hypothyroidism (SCH) in pregnancy has been controversial. Furthermore, the impact of levothyroxine replacement on improving outcomes in pregnant women with SCH is unknown. This study aimed to assess the maternal and neonatal outcomes of pregnant women with SCH who were treated with levothyroxine replacement. METHODS This retrospective chart review was conducted at a tertiary hospital in Iran between 2020 and 2022. All pregnant women who had given birth during the study period were recruited. Those who did not have thyroid function test results within 10-12 weeks, as well as those with SCH who did not have levothyroxine replacement, were excluded. The subjects were divided into two groups based on the 2017 American Thyroid Association (ATA) criteria: non-SCH (TSH values 0.27-2.5 mIU/L) and SCH (TSH values more than 4.0 mIU/L). The demographic, obstetric, maternal, and neonatal outcomes of both groups were compared. The Chi-square test was used to compare the categorical variables. Binary logistic regression was used to assess differences in categorical variables. RESULTS With a frequency of 10.5%, 935 women out of 8888 were diagnosed with SCH. In terms of age, educational level, living residency, medical insurance, access to prenatal care, and smoking status, there were no differences between the two groups. In terms of gestational age, parity, onset of labor, history of infertility, hypertension, cardiovascular disease, anemia, and overt diabetes, there were no differences between the two groups; however, gestational diabetes was more common in those with SCH. Compared with the non-SCH group, the prevalence and risks of gestational diabetes [19.8 vs. 14.2, odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.72-3.95] were significantly higher in the SCH group after controlling for confounding factors. There were no differences in neonatal outcomes between the two groups. CONCLUSIONS Except for gestational diabetes, we found no significant adverse events in terms of maternal and neonatal outcomes among women with SCH who were treated with levothyroxine.
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Affiliation(s)
| | - Farinaz Rahimi
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IRN
| | - Amene Ranjbar
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar abbas, IRN
| | - Farideh Montazeri
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IRN
| | - Fatemeh Darsareh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar abbas, IRN
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Wooldridge A, Chan C, Spaans F, Quon A, Steinback C, Davenport M, Davidge S, Cooke CL. Increased stiffness of omental arteries from late pregnant women at advanced maternal age. Biosci Rep 2023; 43:BSR20230819. [PMID: 37493195 PMCID: PMC10447229 DOI: 10.1042/bsr20230819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 07/27/2023] Open
Abstract
Advanced maternal age (≥35 years) is a risk factor for poor pregnancy outcomes. Pregnancy requires extensive maternal vascular adaptations, and with age, our blood vessels become stiffer and change in structure (collagen and elastin). However, the effect of advanced maternal age on the structure of human resistance arteries during pregnancy is unknown. As omental resistance arteries contribute to blood pressure regulation, assessing their structure in pregnancy may inform on the causal mechanisms underlying pregnancy complications in women of advanced maternal age. Omental fat biopsies were obtained from younger (<35 years) or advanced maternal age (≥35 years) women during caesarean delivery (n = 7-9/group). Arteries (200-300 µm) were isolated and passive mechanical properties (circumferential stress and strain) assessed with pressure myography. Collagen (Masson's Trichrome) and elastin (Verhoff) were visualized histologically and % positively-stained area was assessed. Median maternal age was 32 years (range 25-34) for younger, and 38 years (range 35-42) for women of advanced maternal age. Circumferential strain was lower in arteries from advanced maternal age versus younger women but circumferential stress was not different. Omental artery collagen levels were similar, while elastin levels were lower with advanced maternal age versus younger pregnancies. The collagen:elastin ratio was greater in arteries from advanced maternal age versus younger women. In conclusion, omental arteries from women of advanced maternal age were less compliant with less elastin compared with arteries of younger controls, which may affect how vascular stressors are tolerated during pregnancy. Understanding how vascular aging affects pregnancy adaptations may contribute to better pregnancy outcomes.
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Affiliation(s)
- Amy L. Wooldridge
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Christy Chan
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Floor Spaans
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Anita Quon
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Craig D. Steinback
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Margie H. Davenport
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra T. Davidge
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Physiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Christy-Lynn M. Cooke
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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Diaz NM, Zemtsov GE, Ryan E, Chao A, Santoli CMA, Grace MR, Dotters-Katz SK. Maternal and peripartum risk factors for acute funisitis among term deliveries complicated by intraamniotic infection. Am J Obstet Gynecol MFM 2023; 5:101013. [PMID: 37178719 DOI: 10.1016/j.ajogmf.2023.101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Acute funisitis-the histologic diagnosis of inflammation within the umbilical cord-represents a fetal inflammatory response and has been associated with adverse neonatal outcomes. Little is known regarding the maternal and intrapartum risk factors associated with the development of acute funisitis among term deliveries complicated by intraamniotic infection. OBJECTIVE This study aimed to identify the maternal and intrapartum risk factors associated with developing acute funisitis among term deliveries complicated by intraamniotic infection. STUDY DESIGN After institutional review board approval, we conducted a retrospective cohort study of term deliveries affected by clinical intraamniotic infection at a single tertiary center between 2013 and 2017, with placental pathology consistent with histologic chorioamnionitis. The exclusion criteria included intrauterine fetal demise, missing delivery information or placental pathology, and documented congenital fetal abnormalities. Maternal sociodemographic, antepartum, and intrapartum factors were compared among patients with acute funisitis on pathology to those without acute funisitis using bivariate statistics. Regression models were developed to estimate the adjusted odds ratios. RESULTS Of 123 patients meeting the inclusion criteria, 75 (61%) had acute funisitis on placental pathology. Compared with placental specimens without acute funisitis, acute funisitis was observed more frequently among patients with maternal BMI ≥30 kg/m2 (58.7% vs 39.6%, P=.04) and labor courses with increased rupture of membrane duration (17.3 vs 9.6 hours, P=.001). Use of fetal scalp electrode was observed less frequently in acute funisitis (5.3% vs 16.7%, P=.04) than cases without acute funisitis. In regression models, maternal BMI ≥30 kg/m2 (adjusted odds ratio, 2.67; 95% confidence interval, 1.21-5.90) and rupture of membrane >18 hours (adjusted odds ratio, 2.48; 95% confidence interval, 1.07-5.75) were significantly associated with acute funisitis. Fetal scalp electrode use (adjusted odds ratio, 0.18; 95% confidence interval, 0.04-0.71) was negatively associated with acute funisitis. CONCLUSION In term deliveries with intraamniotic infection and histologic chorioamnionitis, maternal BMI ≥30 kg/m2, and rupture of membrane>18 hours were associated with acute funisitis on placental pathology. As insight into the clinical impact of acute funisitis grows, the ability to predict which pregnancies are at the greatest risk for its development may allow for a tailored approach to predicting neonatal risk for sepsis and related comorbidity.
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Affiliation(s)
- Nicole M Diaz
- Duke University School of Medicine, Durham, NC (Ms Diaz).
| | - Gregory E Zemtsov
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC (Drs Zemtsov and Santoli)
| | - Emma Ryan
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN (Dr Ryan)
| | - Agnes Chao
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham, NC (Dr Chao)
| | - Carmen M A Santoli
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC (Drs Zemtsov and Santoli)
| | - Matthew R Grace
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN (Dr Grace)
| | - Sarah K Dotters-Katz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC (Dr Dotters-Katz)
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Essa A, Kovell LC, Wilkie GL. Mode of delivery and perinatal outcomes by modified World Health Organization classification of maternal cardiovascular risk in pregnancy. Am J Obstet Gynecol MFM 2023; 5:101034. [PMID: 37244641 DOI: 10.1016/j.ajogmf.2023.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Cardiac disease is a leading cause of maternal morbidity and mortality in the United States, and an increasing number of patients with known cardiac disease are reaching childbearing age. Although guidelines indicate that cesarean deliveries should be reserved for obstetrical indications, rates of cesarean delivery among obstetrical patients with cardiovascular disease are higher than those of the general population. OBJECTIVE This study aimed to evaluate mode of delivery and perinatal outcomes among patients with low-risk and moderate to high-risk cardiac disease as defined by the modified World Health Organization classification of maternal cardiovascular risk. STUDY DESIGN We performed a retrospective cohort study of obstetrical patients with known cardiac disease, as defined by the modified World Health Organization cardiovascular classification categories in pregnancy, who underwent a perinatal transthoracic echocardiogram at a single academic medical center between October 1, 2017 and May 1, 2022. Demographics, clinical characteristics, and perinatal outcomes were collected. Comparisons were made between patients with low- (modified World Health Organization Class I) and moderate to high-risk (modified World Health Organization Class II-IV) cardiac disease using chi-square, Fisher exact, or Student t-tests. Cohen d tests were used to estimate the effect size between group means. Logistic regression models were used to evaluate the odds of vaginal and cesarean delivery in low- and moderate to high-risk groups. RESULTS A total of 108 participants were eligible for inclusion, with 41 participants in the low-risk cardiac group and 67 in the moderate to high-risk group. Participants had a mean age of 32.1 (±5.5) years at the time of delivery and a mean pregravid body mass index of 29.9 (±7.8) kg/m2. Chronic hypertension (13.9%) and a history of hypertensive disorder of pregnancy (14.9%) were the most common comorbid medical conditions. In total, 17.1% of the sample had a history of a cardiac event (eg, arrhythmia, heart failure, myocardial infarction). Rates of vaginal and cesarean deliveries were similar between the low- and moderate to high-risk cardiac groups. Patients in the moderate to high-risk cardiac group were more likely to be admitted to the intensive care unit during pregnancy (odds ratio, 7.8; P<.05) and experience severe maternal morbidity compared with patients in the low-risk cardiac group (P<.01). Mode of delivery was not associated with severe maternal morbidity in the higher-risk cardiac group (odds ratio, 3.2; P=.12). In addition, infants of mothers with higher-risk disease were more likely to be admitted to the neonatal intensive care unit (odds ratio, 3.6; P=.06) and have longer neonatal intensive care unit stays (P=.005). CONCLUSION There was no difference in mode of delivery by modified World Health Organization cardiac classification, and mode of delivery was not associated with risk of severe maternal morbidity. Despite the overall increased risk of morbidity in the higher-risk group, vaginal delivery should be considered as an option for certain patients with well-compensated cardiac disease. However, larger studies are needed to confirm these findings.
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Affiliation(s)
- Angela Essa
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA (Dr Essa).
| | - Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA (Dr Kovell)
| | - Gianna L Wilkie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA (Dr Wilkie)
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Whittington JR, Ghahremani T, Whitham M, Phillips AM, Spracher BN, Magann EF. Alternate Birth Strategies. Int J Womens Health 2023; 15:1151-1159. [PMID: 37496517 PMCID: PMC10368118 DOI: 10.2147/ijwh.s405533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Abstract
Community birth is defined as birth that occurs outside the hospital setting. Birthing in a birth center can be safe for certain patient populations. Home birth can also be safe in well-selected patient with a well-established transfer infrastructure should an emergency occur. Unfortunately, many areas of the United States and the world do not have this infrastructure, limiting access to safe community birth. Immersion during labor has been associated with decreased need for epidural and pain medication. Delivery should not occur in water due to concerns for infection and cord avulsion. Umbilical cord non-severance (also called lotus birth) and placentophagy should be counseled against due to well-documented risks without clear benefit. Birth plans and options should be regularly discussed during pregnancy visits.
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Affiliation(s)
- Julie R Whittington
- Department of Obstetrics and Gynecology, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA, USA
| | - Taylor Ghahremani
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Megan Whitham
- Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Amy M Phillips
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bethany N Spracher
- Department of Obstetrics and Gynecology, Edward via College of Osteopathic Medicine, Blacksburg, VA, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Geng Z, Li C, Kong H, Song L. Supreme laryngeal mask airway for cesarean section under general anesthesia: a 10-year retrospective cohort study. Front Med (Lausanne) 2023; 10:1181503. [PMID: 37547618 PMCID: PMC10399215 DOI: 10.3389/fmed.2023.1181503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background Previous research showed the use of supraglottic airways in obstetric anesthesia. The relevant evidence of laryngeal mask airway (LMA) on maternal and neonatal outcomes is still limited. We aimed to assess the maternal and neonatal outcomes when the LMA Supreme was used for cesarean section under general anesthesia. Methods We included all patients who underwent general anesthesia for cesarean section between January 2010 and December 2019. Propensity score matching was used to reduce potential bias from non-random selection of airway intervention. The primary outcome was adverse maternal and neonatal outcomes defined as maternal regurgitation, aspiration, hypoxemia, and low neonatal Apgar scores. Secondary outcomes included patient admission to the intensive care unit, neonate required tracheal intubation, external cardiac massage, and admission to the neonatal intensive care unit. Results A total of 723 patients were included in the analysis; of whom, 221 received Supreme laryngeal mask airway (LMA group) and 502 were intubated with an endotracheal tube (ETT group). After propensity score matching, 189 patients remained in each group. No episode of regurgitation and aspiration occurred in both groups. There was no difference in the rates of Apgar score below 7 at 1 min (14.3% LMA group vs. 15.3% ETT group, OR 0.931, 95% CI 0.574 to 1.510, P = 0.772) and 5 min (3.7% vs. 4.2%, OR 0.875, 95% CI 0.324 to 2.365, P = 0.792). No difference was observed in the secondary outcomes between the two groups. Conclusion The LMA Supreme was not associated with higher adverse maternal and neonatal outcomes when compared to an endotracheal tube for cesarean section under general anesthesia. It might be considered an alternative to tracheal intubation in obstetric practice.
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Affiliation(s)
- Zhiyu Geng
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
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Benevides ML, Andrade BWB, Zambardino HMD, Benevides MAM. A Prospective Single-Center Brazilian Study Investigating the Efficacy and Safety of Prophylactic Phenylephrine Infusion for the Management of Hypotension During Cesarean Section Under Spinal Anesthesia. Cureus 2023; 15:e42156. [PMID: 37602045 PMCID: PMC10438977 DOI: 10.7759/cureus.42156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background Maternal hypotension occurs in up to 80% of parturients during cesarean section (CS) under spinal anesthesia. Phenylephrine, a direct-acting α-1 agonist, has been widely recommended for the prevention of hypotension. We evaluated the efficacy and safety of phenylephrine infusion to prevent hypotension in obese and non-obese patients during cesarean section. Methods One hundred forty-one patients were included in this single-arm study. Patients received prophylactic phenylephrine infusion at a rate of 50 μg/min-1 immediately after spinal local anesthetic injection until delivery. Hypotension was defined as a systolic blood pressure <100 mmHg or <20% of baseline. The primary outcome was the incidence of hypotension. Results The incidence of hypotension was 17%. The median and interquartile range (IQR) of the number of hypotensive episodes was 0 (0-0). It was observed that 79.1% of the patients had hypotension in the first six minutes. Reactive hypertension and bradycardia occurred in 20.5 and 12.7% of the patients, respectively. In addition, there was a higher incidence of bradycardia in pregnant women with a body index mass of < 30 kg/m-2. Patients with baseline systolic blood pressure <120 mmHg had a threefold increased risk of hypotension. The incidence of nausea and vomiting was 13.4 and 2.8%, respectively. The incidence of an Apgar score <7 at the first minute was 2.8%, and no neonates presented an Apgar score <7 at the fifth minute. A pH of <7.2 occurred in 6.3% of the neonates. All neonates had no sequelae and were discharged together with their mothers. Conclusion The prophylactic infusion of phenylephrine 50 μg/min-1 is safe and demonstrates efficacy in reducing maternal hypotension providing adequate maternal hemodynamic stability during CS under spinal anesthesia.
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Affiliation(s)
- Marcio L Benevides
- Department of Anesthesiology, Hospital Geral e Maternidade de Cuiabá, Cuiaba, BRA
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